Treatment of Testicular Embryonal Carcinoma

Testicular embryonal carcinoma is a high-grade tumor. It often spreads metastases, and therefore requires more aggressive treatment tactics. Unlike seminoma, testicular embryonal carcinoma is minimally sensitive to radiation. The main treatment methods for testicular cancer are surgery and chemotherapy. Radiation therapy for testicular cancer is used only at the advanced stage for suppressing metastases. Doctors in developed countries successfully treat testicular embryonal carcinoma at all stages, even at the advanced ones. In most men, testicular cancer does not recur after well-performed surgery and pharmacotherapy.

Content

1. What is testicular embryonal carcinoma
2. Diagnostics of testicular cancer
3. Treatment of cancer
4. Surgical removal of cancer
5. Chemotherapy for testicular cancer
6. Radiation therapy
7. Treatment in Europe with Booking Health at an affordable price

What is testicular embryonal carcinoma

Embryonal cancer refers to testicular germ cell tumors. They are formed from germ cells. These are uncommon neoplasms, accounting for about 1% of all malignant tumors in men. However, a specificity of this cancer is a frequent occurrence in young men. The average age at the time of diagnosis is 35 years.

Embryonal carcinoma is one of the most common components of mixed tumors. According to the results of histological examination, these cancer cells are detected in 40% of patients. However, the proportion of cancer may be insignificant. Other histologic types of cancer, such as seminoma, usually predominate. Pure embryonal cancer occurs in up to 1 in 30 patients with germ cell tumors.

However, the presence of embryonal cancer in the neoplasm worsens the prognosis. It is an aggressive type of cancer  that grows rapidly, metastasizes early, and recurs frequently. The literature describes cases of late cancer metastases that occur 10 and even 20 years after the seemingly successful cure of the pathology. Doctors detect the repeated growth of tumor foci in the liver, lungs, or other organs.

Since cancer recurrence can occur even in the long term, patients continue to be regularly examined after tumor removal. Embryonal carcinoma is characterized by an increase in the tumor marker levels: alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). Therefore, if tests are regularly done, a relapse can be suspected in time. The origin of cancer recurrence can be determined by instrumental diagnostic data.

Since embryonal cancer is considered one of the most aggressive, the presence of such cancer in the tumor changes the treatment regimen. It becomes more aggressive: more chemotherapy and radiation are required after surgery, and more surgical interventions for cancer removal are performed. The proportion of embryonal cancer in the tumor of more than 50% is considered an unfavorable prognostic factor.

Although cancer is aggressive, most cases of oncology are successfully cured abroad. After surgery, patients receive chemotherapy to destroy all remaining cancer cells that may have spread to the lymph nodes or other organs. Pharmacotherapy works well even at the advanced stage of testicular cancer.

Diagnostics of testicular cancer

Embryonal carcinoma causes the same symptoms as any other testicular cancer. In 92% of cases, the patient's first complaint is the presence of a palpable mass in the scrotum. In 50% of cases, cancer causes pain in the scrotum. In 8%, pain becomes the first symptom of cancer and the only reason to see a doctor. At the time of cancer detection, enlarged lymph nodes are palpable in 15% of patients, and intoxication syndrome is detected in 12%, which usually indicates a metastatic stage of testicular cancer.

Imaging diagnostic methods for testicular cancer are:

• Ultrasound examination.
• Chest X-ray, CT scan, MRI, PET – with suspected distant metastases of testicular cancer.

At the time of the diagnosis of cancer, 40% of patients already have metastases in the retroperitoneal lymph nodes, while 20% of patients have distant metastases of testicular cancer.

Treatment of cancer

Therapeutic tactics for embryonal carcinoma depend on the prognosis. According to the IGCCCG classification, patients are divided into three groups: favorable, intermediate and unfavorable prognosis of cancer. The histological type of cancer, stage, presence and location of metastases, tumor marker levels are taken into account.

More than 50% of embryonal cancer is considered a poor prognostic factor. These are more aggressive types of cancer and their treatment is more complex. Therefore, in the fight against embryonal carcinoma, doctors perform more extensive surgical procedures and use more medications for cancer chemotherapy.

Surgical removal of cancer

With embryonal carcinoma of any stage, the testicle is removed. This surgery is called orchifuniculectomy. The intervention for cancer treatment is minimally traumatic. The doctor makes a small incision just above the pubis and removes the testicle along with the spermatic cord.

It contains the vas deferens, large vessels – blood and lymphatic vessels. The cancer can spread through these vessels during the surgery. To prevent this, the doctor ligates the spermatic cord.

At the time of the surgery, it is usually not yet clear what type of cancer the surgeon is dealing with. No biopsy is done to diagnose testicular cancer. The histological type of cancer is determined according to the results of the histological examination of the surgical material obtained. However, taking into account the elevated tumor marker levels, the doctor may suspect that he deals with an aggressive type of cancer even prior to the intervention. In addition, metastases in the retroperitoneal lymph nodes and distant organs can be detected with the help of imaging diagnostics.

In aggressive types of cancer, including embryonal carcinoma, surgical treatment of cancer is complemented by retroperitoneal lymphadenectomy. Even at the first stage, the testicle is removed along with the lymph nodes, because the cancer can recur. Retroperitoneal lymphadenectomy is a more traumatic procedure than testicle removal. It often causes complications for reproductive health, the most common of which is retrograde ejaculation.

Surgical treatment options for cancer are the following:

• Two-stage – the doctor removes the testicle, and if an aggressive type of cancer and other signs of an unfavorable prognosis are detected, then a second intervention is performed to remove the retroperitoneal lymph nodes.
• One-stage – the testicle and retroperitoneal lymph nodes are immediately removed within a single surgery for cancer treatment.

To successfully perform retroperitoneal lymphadenectomy for testicular cancer, the surgeon must have considerable experience. Otherwise, the risk of complications increases. In addition, an inexperienced doctor may not remove all lymph nodes, which increases the risk of cancer recurrence from regional metastases. Therefore, it is important to undergo surgery in a good hospital. The large Cancer Centers abroad employ highly qualified surgeons with vast experience in such surgeries. They can perform high-quality lymphadenectomy, which will be safe for health, and with minimal risk of cancer recurrence.

In the case of testicular cancer, the removal of the retroperitoneal lymph nodes is usually done through a large skin incision. However, hospitals in developed countries also perform laparoscopic and robot-assisted surgeries. Studies show that with sufficient experience of the surgeon, they provide the same oncological results in testicular cancer as open surgery. At the same time, laparoscopic and robot-assisted interventions are safer for health, because:

• They are performed through minimal incisions.
• They reduce blood loss.
• The use of a robot-assisted surgical system reduces the health risks caused by human factors.

After minimally invasive interventions for testicular cancer, patients suffer less pain, complications, recover faster and spend less time in the hospital. They are less likely to need additional treatment, and blood transfusion is less often required.

Chemotherapy for testicular cancer

Chemotherapy for patients with embryonal cancer is an important part of treatment. The decision on the need for this option for cancer treatment is made based on the results of histological examination of the removed material. Doctors determine the type of cancer, the presence of cancer metastases in the lymph nodes, accurately assess the stage of cancer, and also take into account the tumor marker levels: their normalization indicates successful surgical treatment of cancer.

Since embryonal cancer is very aggressive, most patients receive chemotherapy after testicular cancer surgery. Indications for chemotherapy for testicular cancer treatment are as follows:

• Retroperitoneal lymph node dissection has not been performed.
• Retroperitoneal lymph nodes were removed, and cancer metastases were detected in them.
• Tumor marker levels in testicular cancer remain elevated even after surgery.

Sometimes metastases are detected even before surgery, using imaging diagnostics. In this case, doctors often resort to preoperative (induction) chemotherapy. Chemotherapy is then continued after removal of the tumor and metastases.

At the advanced stage, testicular cancer treatment with chemotherapy plays a key role. Metastases spread to the lungs, liver, brain, and other organs. Not all testicular cancer metastases can be surgically removed or destroyed by radiation. In addition, many testicular metastases remain undetected due to their minimal size. Chemotherapy affects all cancer foci at once, regardless of their location. Combined with surgery and radiation, chemotherapy can often help cure even advanced testicular cancer.

For testicular cancer with a high proportion of embryonal carcinoma, more aggressive chemotherapy regimens are used. A total of 3-4 cycles are required. Each chemotherapy cycle lasts 3-4 weeks. There are breaks between cycles so that the body can recover.

In the most severe cases, when the usual doses of chemotherapy drugs for testicular cancer do not work, high-dose chemotherapy with stem cell transplantation is used. This treatment option for testicular cancer is expensive and unsafe, as well as requires a long hospital stay. However, sometimes this is the only way to cure the disease. Higher doses of chemotherapy are more likely to kill all cancer cells in the body. Nonetheless, aggressive chemotherapy destroys the bone marrow, so the formation of blood cells stops. After high-dose chemotherapy, stem cells are injected into the patient's body in order to restore bone marrow.

Radiation therapy

Radiation therapy for testicular cancer is rarely used. Irradiation is not part of the standard treatment for non-seminoma tumors. Basically, radiation is used at the advanced stage or in case of recurrence of testicular cancer.

However, embryonal cancer can rarely be pure. As a rule, it is only one of the components of mixed tumors. A large proportion of cancer can be seminoma. This is the most common type of testicular cancer. Seminoma is very sensitive to radiation. It can be destroyed even with a small dose of radiation. Therefore, if there is a significant proportion of seminoma in the tumor, doctors may carry out a course of postoperative radiation therapy.

Nevertheless, radiation is rarely used for testicular cancer. Whenever possible, doctors prefer chemotherapy, even if there are seminoma cells in the tumor, because it is safer and more effective.

Radiation is mainly used at the advanced stages of testicular cancer. Brain metastases are destroyed with the help of radiation. Radiation is chosen when a tumor bleeds or cancer causes severe central nervous system symptoms. However, if the threat of complications is minimal, then chemotherapy is preferred for cancer treatment – although it does not work so quickly, it provides better results with a lower risk of complications.

Treatment in Europe with Booking Health at an affordable price

To undergo treatment of seminoma and testicular embryonal carcinoma in one of the European hospitals, you can use the services of the Booking Health company. On our website, you can see the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Seminoma and testicular embryonal carcinoma treatment at a European hospital will be easier and faster for you, and the cost of cancer treatment will be lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a consultation on treatment in Europe. Booking Health will fully organize your trip abroad. We will provide the following benefits for you:

• We will choose the best European hospital, whose doctors specialize in the treatment of testicular embryonal carcinoma.
• We will help you overcome the language barrier and establish communication with the doctor of the European hospital.
• We will reduce the waiting time for the medical care program. You will undergo treatment for testicular embryonal cancer or seminoma on the most suitable dates for you.
• We will reduce the price. The cost of treatment in Europe will be reduced due to the lack of overpricing and additional coefficients for foreign patients.
• We will take care of all organizational issues: we will prepare documents, meet you abroad and take you to the hospital, book a hotel, and provide interpreting services.
• We will prepare a program and translate medical records. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with doctors after the completion of treatment in Europe.
• We will organize additional diagnostic examinations and cancer treatment in European hospitals.
• We will buy medicines abroad and forward them to your native country.

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help you reduce the cost of treatment, organize your trip to the European hospital, and you will only have to focus on restoring your health.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko