Testicular seminoma (pure) stage II

What is Stage II Seminoma?

Stage II seminoma is a type of testicular cancer that has spread beyond the testicle to nearby lymph nodes (small glands that help fight infection) in the abdomen or pelvis. Seminoma is a germ cell tumor, which means it starts in the cells that would normally develop into sperm1. Despite having spread to lymph nodes, this cancer remains highly treatable and curable2.

Pure seminoma means the tumor contains only seminoma cells and no other types of testicular cancer cells. This distinction is important because pure seminomas respond very well to treatment and have excellent cure rates3.

Understanding Stage II Classifications

Stage II seminoma is divided into three substages based on the size and number of affected lymph nodes4:

Stage 2A means the cancer has spread to no more than 5 nearby lymph nodes, and all these lymph nodes are 2 centimeters or smaller in size4.

Stage 2B means one of the following: the cancer has spread to at least one lymph node that is larger than 2 centimeters but no larger than 5 centimeters, or it has spread to more than 5 lymph nodes (but all are smaller than 5 centimeters), or the cancer has grown through the outer covering of the lymph node4.

Stage 2C means the cancer has spread to at least one lymph node that is larger than 5 centimeters4.

At any of these stages, you may have normal or slightly raised levels of certain substances in your blood called tumor markers4. These markers help doctors monitor how well treatment is working.

Associated Anatomy

• Testicles
• Retroperitoneal lymph nodes (lymph nodes behind the abdominal cavity)
• Pelvic lymph nodes
• Spermatic cord

Signs and Symptoms

The most common symptom of seminoma is a painless lump or swelling in one testicle. Many men or their partners discover this lump by accident1.

Other symptoms you might experience include a feeling of heaviness in your testicles or scrotum, or a dull ache in your testicles or the area between your legs1.

When seminoma has spread to lymph nodes in stage II, you might notice additional symptoms. These can include lumps in the lymph nodes of your neck, persistent cough, shortness of breath, nausea and vomiting, or gastrointestinal bleeding1.

How Doctors Diagnose Stage II Seminoma

Doctors use several tests to diagnose and stage seminoma. First, they will perform a physical examination and ask about your symptoms2.

Blood tests are essential because they measure levels of tumor markers including alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH). Pure seminoma does not produce AFP, so if this marker is elevated, it suggests the presence of other cancer cell types3. However, approximately 14% of patients with stage I pure seminomas have elevated beta-hCG before surgery3.

Imaging tests such as CT scans (computed tomography) of the abdomen and pelvis help doctors see if cancer has spread to lymph nodes and determine their size. Ultrasound of the testicle can help identify the tumor itself4.

The definitive diagnosis comes from surgery to remove the affected testicle, called a radical inguinal orchiectomy. The removed tissue is examined under a microscope to confirm it is pure seminoma2.

Treatment Options

Surgery is the first step in treating stage II seminoma. The procedure, called a radical inguinal orchiectomy, removes the entire affected testicle and the spermatic cord through a small opening in the groin5. This surgery provides both diagnosis and initial treatment.

After surgery, additional treatment depends on which substage you have. For stage 2A seminoma, you may be offered either radiation therapy or chemotherapy after surgery. If tumor marker levels in your blood are not elevated, active surveillance (careful monitoring with regular checkups) may also be an option5.

Radiation therapy directs high-energy beams at the lymph nodes in the back of your abdomen and sometimes in your pelvis. This treatment is commonly offered for stages 2A and some 2B seminomas5.

Chemotherapy uses drugs to kill cancer cells throughout your body. This is the preferred treatment for stage 2B and 2C seminomas, and may also be used for stage 2A6. The most common chemotherapy combinations include BEP (bleomycin, etoposide, and cisplatin) or EP (etoposide and cisplatin). These drugs are given through a needle in your vein5. EP may be used instead of BEP if there are concerns about lung damage from bleomycin5.

For stage 2C seminoma with good prognosis, treatment typically involves three to four cycles of chemotherapy with BEP or EP3. Chemotherapy cures the vast majority of stage II seminomas7.

Recent studies have explored using surgery to remove affected lymph nodes (called retroperitoneal lymph node dissection) as an alternative to chemotherapy or radiation, particularly for smaller lymph nodes. However, this approach is still being studied and may have higher relapse rates than standard treatments6.

Outlook and Survival

The outlook for stage II seminoma is very good. Pure seminoma with good prognosis, which includes most stage II cases where the cancer has spread only to lymph nodes, has a 5-year survival rate of 95%. This means 95 out of every 100 men survive for 5 years or more after diagnosis8.

Treatment for stage II seminoma is usually very effective and can cure most people1. For patients with seminomas at all stages combined, the cure rate exceeds 90%3.

Chemotherapy with regimens like BEP or EP has a cure rate of approximately 96% for stage II seminoma7. Even with intermediate prognosis (when seminoma has spread beyond the lungs or lymph nodes), almost 90 out of every 100 men survive for 5 years or more after diagnosis8.

Having one testicle removed will not affect your ability to have an erection, experience orgasm, or father biological children, as the remaining testicle can function normally1. If you're concerned about fertility, you can discuss sperm banking with your doctor before starting treatment6.