Testicular Cancer - Natural History

  • Testis cancer follows classic anatomic pathways in a stepwise pattern of spread. The tunica albuginia resists spread and the escape pathway is through the testicular mediastinum. Lymphatic spread is very common and right sided lesions demonstrate a right to left pattern of dissemination. The exception to this is choriocarcinoma which demonstrates vascular dissemination.
  • Whereas pure seminoma is confined to the testis at initial presentation in two thirds to three fourths of cases, up to two thirds of patients with NSGCT may present with metastasis. Lymphatic spread can occur early and usually precedes vascular invasion. Early vascular invasion is noted frequently in pure choriocarcinoma. Sites of hematogenous spread include the lungs, liver, and bones.
  • In patients with organ-confined disease after orchiectomy (stage I or A), failure will ultimately occur in 30 percent of patients (80 percent retroperitoneal; 20 percent distant). If a retroperitoneal lymph node dissection is performed for stage I disease, 5 to 8 percent of such patients will have a recurrence, almost exclusively at an extra retroperitoneal site, usually in the chest.
  • All germinal cell testis tumors in adults should be treated as malignant. Spontaneous regression of this disease is extremely rare. The majority of patients who die from testicular cancer do so within 3 years of diagnosis.


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