Epidemiology of Seminoma

Dr. Bruce Roth, Professor of Oncology in the Division of Medicine at Siteman Cancer Center, Washington University at St. Louis, spoke with Cancer Network at the 2013 ASCO meeting about topics in seminoma. Here he discusses the epidemiology of seminoma and how he evaluates a patient with newly diagnosed stage I seminoma.

Cancer Network: Welcome! Testicular cancer is the most common cancer among young men, and there’s a secondary peak incidence after age 60. For unknown reasons, the incidence of testicular cancer is increasing and has nearly doubled in most Western countries over the past several decades; in fact, Denmark has the highest incidence and East Asia has the lowest. Can you give some very brief background information on the epidemiology of seminoma in particular?

Dr. Roth: So, despite the fact that [seminoma is] the most common tumor in [males in] the 15- to 35-year age range, it’s still a relatively uncommon tumor. There are about 7,200 cases in North America this year, with about 400 deaths. Overall, the average oncologist might see 1 case a year, and so it’s important to have guidelines, and have centers of excellence, to basically determine how these patients should be treated so there’s not a lot of wide variation in [the management of] a highly curable malignancy.

Cancer Network: Could you please describe your initial evaluation of a patient with clinical stage I seminoma?

Dr. Roth: For a patient that comes in with clinical stage I [seminoma], namely [disease] clinically confined to the testicle-and that’s about 80% of patients with seminoma who present; it’s the rare patient who presents with metastatic disease-patients get [assessed for] serum tumor markers, and HCG [human chorionic gonadotropin], and alfa fetoprotein, and LDH [lactate dehyrogenase]. They get some imaging of the chest, usually with chest X-ray. They get an abdominal pelvic CT scan, and then [information from] that, along with physical examination is used to determine whether they are clinical stage I or [have] more advanced disease.