Testicular Cancer Treatment in Delhi Gurgaon India – Best Cancer Specialist

What are testes and what is their Anatomy?

Testes (singular: testis or testicle) are paired, oval-shaped, male-reproductive glands, which sit in the scrotum (supporting structure for the testes which hangs beneath the base of the penis) and measure about 5 cm in length and 2.5 cm in diameter.  

human testis anatomy

 

  They normally develop in the abdomen and descend into the scrotum through the inguinal canals during the seventh month of fetus development. The main function of the testes is to produce sperms and the male hormones (androgens) such as testosterone.  

What are the types of Testicular Cancers?

The testes are made up of mainly 3 types of cells: spermatogenic cells (germ cells), Sertoli cells, and interstitial (or Leydig) cells. Each of these cells can develop into one or more types of cancer. Germ cell tumors are the most commonly encountered (around 90-95% of all cases) testicular cancer. Germ cell tumors are classified into following 2 types based on the type of cells involved, growth rate, and type of treatment approach usually followed for such tumors:

  1. Seminomas
  2. Non-seminomas

 

How is the Staging for Testicular Germ Cell Tumors done?

TNM is the most commonly used system for staging testicular cancer. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, “M” for “Metastasis”, and “S” stands for “Serum level of tumor markers”.

T STAGING

Tis – The cancer cells are present only in the seminiferous tubules (small tube-like structures inside the testes).

T1 – Tumor limited to testis/epididymis and has invaded up to the tunica albuginea but has not grown into tunica vaginalis or nearby blood vessels/lymphatics.

T1-infiltrates into the tunica albuginea

 

T2 – Tumor limited to testis/epididymis and has invaded up to the tunica vaginalis or blood vessels/lymphatics involvement by the tumor.

T2-infiltrates into the tunica vaginalis

 

T3 – Tumor has invaded the spermatic cord with or without blood vessels/lymphatics involvement.

T3-infiltrates into the spermatic cord

 

T4 – Tumor has invaded the scrotum with or without blood vessels/lymphatics involvement.

T4-infiltrates into scrotum

 

N STAGING

N0 – No spread to regional lymph nodes

N1 – Tumor spread to single or multiple regional lymph node(s) none >2 cm in greatest dimension

N2 – Tumor spread to single or multiple regional lymph node(s), any one >2 cm but </=5 cm in greatest dimension

N3 – Tumor spread to lymph node mass >5 cm in greatest dimension 

 

N staging-metastasis to retroperitoneal lymph nodes

 

M STAGING

M0 – No spread to non-regional lymph nodes or distant body parts.

M1a – Tumor spread to non-regional lymph nodes or lungs  

For example, spread to mediastinal lymph nodes

 

M1a-involvement of lymph nodes in the mediastinum

 

Or Inguinal lymph nodes

 

M1a-involvement of inguinal lymph nodes

 

Or Left supraclavicular lymph node 

M1a-involvement of left supraclavicular lymph node

 

Or metastasis to one or both the lungs (pulmonary metastasis)

M1a-lung metastasis

 

M1b – Tumor spread to distant sites other than non-regional lymph nodes or lungs Like spread to liver

M1b-liver metastasis


Spread to brain or bones is also M1b.  

 

Testicular Tumor Serum Marker Levels

S0 – Normal tumor marker levels.

S1 – Tumor markers are elevated [LDH <1.5 × upper limit of normal, and beta-HCG <5000 mIU/ml, and AFP <1000 ng/ml].

S2 – Tumor markers are elevated (LDH=1.5-10 × upper limit of normal, or beta-HCG=5000-50000 mIU/ml, or AFP=1000-10000 ng/ml).

S3– Tumor markers are elevated [LDH >10 × upper limit of normal, or beta-HCG >50000 mIU/ml, or AFP >10000 ng/ml].  

 

Once T, N, M, and S categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

STAGE TNM  
0 Tis N0 M0 S0  
IA T1 N0 M0 S0  
IB T2 N0 M0 S0  
     
  T3 N0 M0 S0  
     
  T4 N0 M0 S0  
IS Any T N0 M0 S1-3  
IIA Any T N1 M0 S0-1  
IIB Any T N2 M0 S0-1  
IIC Any T N3 M0 S0-1  
IIIA Any T Any N M1a S0-1  
IIIB Any T N1-3 M0 S2  
     
  Any T Any N M1a S2  
IIIC Any T N1-3 M0 S3  
     
  Any T Any N M1a S3  
     
  Any T Any N M1b Any S  

 

What is the Treatment of Testicular Germ Cell Tumor?

The testicular cancer treatment depends on the type of testicular cancer (seminoma versus non-seminoma), stage of the disease, performance status of the patient, along with other factors.  

Treatment of Seminoma Testis

Stage 0

Tis N0 M0 S0 Surveillance is generally preferred approach for patients with Stage 0 seminomas. The patient should be screened frequently for any sign of disease progression. No other treatment is generally recommended.

Stage I 

T1-4 N0 M0 Sx In case of Stage I seminomas, high inguinal orchiectomy (complete removal of the affected testicle) followed by surveillance is the preferred option, mainly for T1-T3 disease. However, chemotherapy or radiation therapy is also an option after high inguinal orchiectomy.

Stage II 

Any T N1-3 M0 Sx In case of Stage II seminomas, high inguinal orchiectomy followed by radiotherapy (for non-bulky disease or stage IIA) or chemotherapy (for bulky disease or stage IIB/IIC) is considered as the standard treatment.

Stage III 

Any T Any N M1 Sx In case of Stage III seminomas, radical inguinal orchiectomy followed by chemotherapy is the standard treatment. Radiation therapy and/or other palliative treatment may be given for relief of symptoms.  

Treatment of Non-Seminoma Testis

Stage 0 

Tis N0 M0 S0 Surveillance is generally preferred approach for patients with Stage 0 non-seminomas. The patient should be screened frequently for any sign of disease progression. No other treatment is generally recommended.

Stage I 

T1-4 N0 M0 Sx In case of Stage I non-seminomas, high inguinal orchiectomy followed by surveillance is preferred for T1 disease. However, for T2-T4 tumors, chemotherapy or nerve-sparing retroperitoneal lymph node dissection (RPLND) are preferred after high inguinal orchiectomy.

Stage II 

Any T N1-3 M0 Sx In case of Stage II non-seminomas, high inguinal orchiectomy followed by RPLND (for non-bulky disease or stage IIA; with tumor marker(s) normal) or chemotherapy (for bulky disease or stage IIB/IIC, or tumor marker(s) elevated) is considered as the standard treatment.

Stage III 

Any T Any N M1 Sx In case of Stage III  non-seminomas, radical inguinal orchiectomy followed by chemotherapy is the standard treatment. Radiation therapy and/or other palliative treatment may be given for relief of symptoms.

 

What are the Surgeries done for Testicular Germ Cell Tumors?

testicular cancer surgery

Mainly 2 types of surgeries are performed for testicular cancer treatment: High inguinal orchiectomy and retroperitoneal lymph node dissection (RPLND).

In high inguinal orchiectomy, the affected testicle, spermatic cord, and associated blood and lymph vessels (that can provide passage for cancer spread) are removed. In RPLND, the cancer-containing lymph nodes in the abdomen (known as retroperitoneal lymph nodes surrounding the aorta and inferior vena cava) are removed. RPLND can be performed as an open surgery or as a laparoscopic procedure. Also, some patients may opt for sperm banking for fertility preservation before the surgery.  

Best Testicular Cancer Specialist in Delhi

Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating testicular cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.

He has a vest experience of treating testicular cancer patients in all stages of disease. He is well versed with Chemotherapy for Testicular Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.

Call +91 9686813020 for appointment.