Malignant testicular tumors
Malignant testicular tumors. About 1% of all tumors are in men. They occur with a frequency of 20-25 per 1 million men, most often at the age of 20-35 years. Factors predisposing to the onset of tumors are cryptorchidism, late egg re-entry (after 6 years), trauma. There are germinogenic tumors (95%) emanating from the seed epithelium, and non-germogenic, originating from the cells that produce hormones, and from the stroma (5%).
Germinogenic tumors-seminomas (40%) and non-seminoma (embryonic cancer, teratoma, chorionepithelioma, yolk sac tumor). Nonseminomnye tumors often have a mixed character, consist of different components, including seminoma. Seminomas are more often found in people older than 30 years, non-seminoma - from 20 to 36 years.
Symptoms of testicular tumors are a painless, gradually increasing compaction. The main symptomatology is associated with metastasis in the retroperitoneal lymph nodes (patients have painful pain in the lower back) and lungs, which leads to the appearance of coughing, hemoptysis. Often observed gynecomastia. In the biochemical study of blood in non-seminoma tumors, a-fetoprotein is detected. With chorioepithelioma of the testicles in the urine, the content of the chorionic gonadotropin increases. Intravenous urography, ultrasound examination of the retroperitoneal space, computed tomography, angiography allow to establish metastases in the retroperitoneal space.
Treatment of patients begins with the performance of orhofunikupktomii. After histological examination of the tumor, the tactics of treatment may be different. With seminoma without metastases, it is possible to limit the removal of the primary tumor focus. In the presence of retroperitoneal metastases, radiotherapy is performed according to a radical program. When detecting metastases in the lungs or other organs, chemotherapy (sarcolysine, cyclophosphamide, cisplatin, vinblastine) is indicated.
In patients with non-seminoma tumors, if prompted after retroperitoneal surgery, retroperitoneal metastases are performed on both sides, followed by chemotherapy (cisplatin, bleomycin and vinblastine, dactinomycin, adriamycin, olivomycin). If it is impossible to remove retroperitoneal metastases, 5-6 cycles of chemotherapy are performed according to the above scheme. If after a chemotherapy the patient has metastases, they are removed by an operative route. This treatment can cure 70-80% of patients. Non-germogenic tumors are less malignant, they are treated mainly in a surgical way.
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