Management of carcinoma in situ

Carcinoma in situ will progress to invasive cancer, either seminoma or teratoma, with 50% producing invasive tumours five years from diagnosis. Once this diagnosis is made, treatment should be offered, although this may not need to be given immediately. Carcinoma in situ can be eradicated by low-dose radiotherapy to the testis (20 cGy in 10 fractions given over two weeks). The advantage of this treatment is that, in the majority of cases, it will not affect Leydig cell function, and long-term hormone therapy with its attendant problems should not be necessary.

Table 22.8 IGCCCC prognostic grouping

Teratoma (NSGCT)

Seminoma

Good prognosis with all of:

Testis/retroperitoneal primary

Any primary site

No non-pulmonary visceral metastases

No non-pulmonary

visceral metastases

AFP <1000 ng/ml

Normal AFP

HCG <5000 iu/ml

Any HCG

LDH 1.5 upper limit of normal

Any LDH

56% of teratomas: 5-year survival 92%

90% of seminomas: 5-

year survival 86%

Intermediate progress with any of:

Testis/retroperitoneal primary

Any primary site

No non-pulmonary visceral metastases

Non-pulmonary visceral

metastases

AFP >1000 and <10 000 ng/ml

Normal AFP

HCG >5000 and <50 000 iu/ml

Any HCG

LDH >1.5 normal <10 normal

Any LDH

28% of teratomas: 5-year survival 80%

10% of seminomas:

5-year survival 73%

Poor prognosis with any of:

Mediastinal primary

No patients in this group

Non-pulmonary visceral metastases

AFP >10 000 ng/ml

HCG >50 000 iu/ml

LDH >10 normal

16% of teratomas: 5-year survival 48%

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