Seminoma is a germ-cell tumour of the testis. Its first-line management follows a defined surgical pathway, and treatment success is assessed through specific serum tumour markers in the period following the procedure.

Treatment Approach

First-line management centres on a specific surgical intervention. This step also secures the histological diagnosis and must be completed before additional treatment decisions are made. The full protocol details the procedure, its clinical requirements, and the criteria that govern its timing.

Clinical Goals

After the surgical step, normalisation of serum tumour markers — AFP, beta-hCG, and LDH — is the key treatment target. Marker kinetics following surgery carry prognostic weight; persistent or rising values indicate the need for further evaluation.

References

DOI: 10.1016/j.annonc.2022.01.002

Radical orchiectomy provides the histological diagnosis and should be carried out before any further treatment, unless the clinical situation requires immediate ChT in patients with elevated tumour markers and a clinical presentation of a typical germ-cell malignancy.
Radical orchiectomy is carried out through an inguinal incision.
Post-orchiectomy levels of serum tumour markers are nevertheless important for prognostic stratification and should be followed in patients with initially elevated markers (AFP half-life is 5-7 days and b-hCG half-life is 1-3 days) until normalisation.
Persistent or increasing tumour markers after orchiectomy usually indicate metastatic disease.

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First-Line Treatment of Seminoma