Abstract

ALVAREZ MORATINOS, B. et al. Seminoma: an update. Sanid. Mil. [online]. 2013, vol.69, n.1, pp.22-37. ISSN 1887-8571.  https://dx.doi.org/10.4321/S1887-85712013000100004.

Objectives: To review and update the epidemiological aspects, risk factors (mainly genetic and immunohistochemical aspects), diagnosis and treatment of the seminoma. Material and Methods: A literature review has been carried out, using the keyword «seminoma» and the subheadings «diagnosis», «epidemiology», «etiology», «genetics», «mortality» and «treatment» without restrictions on types of study, selecting those articles considered of interest for a review. Information has been completed with other bibliographic references as clinical guidelines, cancer registries and Oncology and Urology texts. The search was limited to articles in English and Spanish. The Surveillance, Epidemiology and End Results Program (SEER) has also been used to obtain data on cancer incidence and mortality in the US, while GLOBOCAN was utilized to obtain data on other 184 countries. Results: A total of 3131 articles have been reviewed, covering a search period from the 1^st January 1990 to 31^st March 2012. The search included 51 reviews on tumor epidemiology, 23 on genetic risk factors, 66 reviews on different aspects of diagnosis and treatment, a prospective study and three randomized studies, including as well the guidelines of 3 Clinical Guides. Conclusions: The germ cell tumor of the testicle (TCGT) is the most common solid tumor in males between the ages of 20 and 34, and the seminoma represents 40-50% of all of them. The risk factors are multiple, congenital and acquired, in particular familial predisposition and bilaterality, cryptorchidia and some chemical carcinogenic agents considered as endocrine disruptors that might favor the development of these tumors. The increase of testicular volume and the palpation of a hard nodule, painful or not, and of variable size is the most common initial symptom. In the diagnosis the testicular sonography and tumor markers AFP and β-hCG play an important role. These tumor markers are oncofetal substances which are besides very useful in the grading and the monitoring of the response to the treatment. Currently three grading systems of these tumors are available and their joint utilization allow adapting the treatment to the risk reaching survival rates over 98% in 5 years. The first choice treatment of the seminoma in the stadium I is radical orchiectomy although there are some discrepancies about adjuvant treatment. Currently three options are considered: surveillance, chemotherapy with platinum derivatives and radiotherapy. For stadiums II and III the options after radical surgery are radiotherapy with or without chemotherapy.

Keywords : Seminoma; Risk factors; Genetics; Immunohistochemistry; Prognostic factors; Chemotherapy; Radiotherapy.

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