Testicular Cancer Survival On Rise Due to Greater Multidisciplinary Team Work

Scott Eggener, MD

Scott Eggener, MD, Associate Professor of Surgery, Section of Urology, was in Abu Dhabi this past weekend attending the Emirates Oncology Conference, one of many cancer experts from around the world participating in the three-day gathering.

Eggener (@uroegg) is one of a number of University of Chicago Medicine faculty and researchers who share their knowledge and expertise at various international conferences every year.

The urologic oncology group presented three posters at the meeting and Eggener gave a podium presentation on the role of RPLND in the multidisciplinary treatment of testicular cancer.

RPLND stands for retroperitoneal lymph node dissection, a procedure that removes lymph nodes in the abdomen as a way to treat metastasized testicular cancer.

Here is an edited transcript of a brief Q&A with Eggener:

Q: What is the role of RPLND in the multidisciplinary treatment of testes cancer?

A: Testicular cancer is the model of effective multidisciplinary care. It brings together specialists in chemotherapy, surgery, and radiation, an approach that has led to unparalleled cure rates for metastatic disease. Over the last 40 years, five-year survival rates have increased from 63% to 96%.

No other cancer is associated with such high cure rates following surgery or chemotherapy for metastatic disease to the abdomen, chest, or elsewhere. A significant number of boys/men will be cured following RPLND, depending, of course, on the specifics of the individual cases.

Q: Why does testes cancer have a usual pattern of spread? What about that particular cancer makes metastasis predictable?

A: Elegant studies from decades ago showed that when testicular cancer metastasizes, >90% of the time it travels to the lymph nodes in the back of the abdomen. The reason for this location is that in utero, the testicles are in the retroperitoneum (the upper part of the back of the abdomen near the kidneys).

Over time, they slowly descend and eventually end up in the scrotum. The blood supply of the testicles originates in the retroperitoneum so, the lymphatic spread of testicular cancer usually travels along this same path to the retroperitoneal lymph nodes.

Q: What is the usual course of treatment for testicular cancer at the University of Chicago Medicine?

A: It depends primarily on three things: the type of testicular cancer (seminoma vs non-seminoma), the levels of certain proteins in the blood (AFP and beta-HCG) and the results of a CT scan looking for metastases. All patients with testicular cancer at UCM are presented at a multidisciplinary oncology conference attended by surgeons, medical oncologists, radiation oncologists, pathologists, and radiologists.

Certain patients with testicular cancer require RPLND and for others it is an option amongst many treatment choices. It depends on the specifics of their cancer.

RPLND is traditionally done through an open incision. But for certain patients, it can be done robotically, which leads to a shorter hospital stay – usually one night – a smaller incision, less pain, and quicker return to normal function. We are one of a handful of hospitals in the country with experience in robotic RPLND.

Q: While the spread of testicular cancer in the body is fairly well known, are there any distribution patterns of the disease worldwide?

A: A study we published two years ago found that testicular cancer rates were highest in Western Europe, Northern Europe and Australia, while Asia and Africa had the lowest incidence. Mortality rates widely vary throughout the world. In countries with testicular cancer expertise and resources, cure rates are over 90%.

In other parts of the world, the only treatment is removal of the testicle and if that isn’t curative, he will eventually die from the disease.

Our group has also generated data from Europe and the United States showing that rates of testicular cancer appear to be steadily increasing. There are many hypotheses but no one is quite sure why this is happening.

Q: What other conferences have you participated at?

A: Attending and speaking at conferences is one of the many ways we share our work and learn from others. This year I have spoken about prostate and testicular cancer at the Chilean Urologic Congress, Palestinian Urologic Society meeting, and International Focal Therapy of Prostate Cancer Meeting (Netherlands). It’s always fascinating and instructive to discuss diagnosis and treatment of urologic cancers with international colleagues.

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