Seminoma Testicular Cancer in Singapore

Classical seminoma represents about 85% of all seminoma cases and typically occurs in men between 30-40 years old. This type grows relatively slowly and responds well to radiation therapy. The tumour cells appear uniform under microscopic examination and rarely spread beyond nearby lymph nodes.

Anaplastic seminoma accounts for 5-10% of seminomas and displays more aggressive cellular features. Despite its more aggressive appearance under the microscope, it responds similarly to treatment as classical seminoma. This variant may present with slightly larger tumours at diagnosis.

This rare variant comprises less than 5% of seminomas and typically affects older men above 50 years. Spermatocytic seminoma grows very slowly and rarely spreads to other parts of the body. The prognosis for this type is good, with surgical removal alone often being curative.

The exact cause of seminoma remains unknown, though researchers believe it results from genetic mutations in germ cells. These mutations cause normal cells to grow uncontrollably, forming tumours. Environmental and developmental factors during foetal development may contribute to these cellular changes.

• Undescended testicle (cryptorchidism) – Men with a history of undescended testicles have 3-5 times higher risk
• Family history – Having a father or brother with testicular cancer increases risk
• Previous testicular cancer – 3-4% chance of developing cancer in the opposite testicle
• Klinefelter syndrome – Genetic condition associated with increased risk
• Age – Most common between 25-45 years for seminoma
• Race – Higher incidence in Caucasian men compared to Asian populations
• Testicular dysgenesis syndrome – Conditions affecting testicular development
• HIV infection – Slightly elevated risk in HIV-positive individuals

The urologist performs a careful examination of both testicles, abdomen, and lymph nodes. This examination helps identify the primary tumour and detect any obvious spread. The affected testicle typically feels firm and cannot be separated from the tumour mass.

High-frequency sound waves create detailed images of the testicular tissue. This non-invasive test can distinguish between solid tumours and fluid-filled cysts with over 95% accuracy. Results are usually available immediately, guiding further management decisions.

Specific blood tests measure alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH). Pure seminomas typically show normal AFP levels, while β-hCG may be slightly elevated in 10-20% of cases. These markers help with diagnosis, staging, and monitoring treatment response.

Computed tomography scans of the chest, abdomen, and pelvis determine the cancer’s extent. These scans identify lymph node involvement and distant metastases. Post-surgery CT scans guide additional treatment decisions and long-term surveillance protocols.

Following surgical removal, the tumour undergoes microscopic analysis by a pathologist. This examination confirms the seminoma diagnosis and identifies specific subtypes. The pathology report provides crucial information for treatment planning and prognosis.

This surgical procedure involves removing the affected testicle through an incision in the groin. The surgery takes approximately one hour under general anaesthesia. The surgeon removes the entire testicle along with the spermatic cord up to the internal inguinal ring. This approach prevents cancer cell spillage and provides tissue for accurate diagnosis. Most patients return home the same day or after an overnight stay.

Following orchiectomy for early-stage seminoma, active surveillance involves regular monitoring without immediate additional treatment. Patients undergo blood tests every 1-2 months initially, CT scans every 3-6 months, and physical examinations. This approach suits patients with stage I disease and avoids unnecessary treatment side effects. Approximately 80% of patients remain disease-free with surveillance alone.

External beam radiation targets lymph nodes in the abdomen and pelvis where seminoma cells might have spread. Treatment typically involves daily sessions over 2-3 weeks using precisely focused radiation beams. Modern techniques minimise exposure to surrounding healthy tissue. Seminomas show sensitivity to radiation, with cure rates exceeding 95% for early-stage disease.

Systemic chemotherapy uses medications to destroy cancer cells throughout the body. Standard regimens include carboplatin (single agent) or combination therapy with etoposide and cisplatin (EP) or bleomycin, etoposide, and cisplatin (BEP). Treatment cycles last 3-4 weeks, with most patients requiring 1-4 cycles depending on disease stage. Chemotherapy achieves good cure rates even in advanced seminoma.

This surgical procedure removes lymph nodes from the back of the abdomen. Though less common for seminoma than non-seminoma tumours, it may be necessary for residual masses after chemotherapy. The surgery requires specialised expertise to preserve nerve function and minimise complications. Most patients stay in hospital for 3-5 days post-surgery.

For rare cases of recurrent or refractory seminoma, high-dose chemotherapy with stem cell transplant offers potential cure. Alternative chemotherapy regimens using different drug combinations target resistant cancer cells. These intensive treatments require careful patient selection and specialised cancer centre expertise.