Seminoma

　　1. Incomplete descent of spermatocytic cells

　　This is the main cause of the disease. Local temperature increase of the testicle, circulatory disorders, and endocrine dysfunction lead to testicular atrophy, spermatogenic disorders, and an increased risk of malignancy. In addition, congenital testicular dysfunction and incomplete descent are also prone to malignancy.

　　2. Genetics

　　In recent years, some people have calculated that about 16% of close relatives of patients with spermatocytic tumors have a family history of tumor disease.

　　3. Testicular feminization syndrome

　　According to the comparative analysis of spermatocytic tumor classification by the World Health Organization (WHO) in 1977, the testicular feminization syndrome is also prone to spermatocytic tumors.

　　4. Trauma

　　It is believed that trauma is not the direct cause of tumor occurrence, but after testicular trauma, there may be small hematomas or circulatory disorders, tissue degeneration and atrophy, etc., which may lead to the occurrence of tumors on this basis.

　　5. Infection

　　Various viral diseases, such as measles, smallpox, viral parotitis, and bacterial inflammation, can all be complicated with orchitis, leading to deformation of testicular cells and the occurrence of spermatocytic tumor.

　　6. Hormones

　　Clinical and animal experiments, among other facts, suggest that endocrinology is related to the cause of testicular tumors. For example, testicular tumors are more common in the young and middle-aged, or during the active period of endocrine function; animal experiments such as long-term administration of estrogen to rodents can induce spermatocytic tumors. According to traditional Chinese medicine, emotional disharmony, or anger and liver injury, lead to liver qi stagnation, which invades the spleen, causing spleen deficiency and dampness accumulation, remaining in the liver meridian, forming a hard mass over time. 'Deficiency of body resistance and excess of pathogenic factors' is its pathological mechanism.

　　Spermatocytic tumor spreads through four ways

　　1. Within the testicular tissue, the cancer cells spread within the ipsilateral testicle.

　　2. The cancer cells of the testicle enter the lymphatic system for growth, known as lymphatic metastasis, with intrathoracic involvement being around the bronchus, hilum, and mediastinal lymph nodes; extrathoracic involvement is around the supraclavicular, axillary, and upper abdominal lymph nodes.

　　3. The cancer cells of the testicle enter the blood system for growth, known as hematogenous metastasis, with the most common site being lung metastasis, followed by growth in the liver, bones, and other places.

　　4. Iatrogenic metastasis, which occurs during Western surgery when cancer cells are planted in the abdominal cavity or at the incision, is more common.

　　1. Clinical staging

　　The pathological type of spermatocytic tumor is related to the prognosis, and the extent of tumor spread and the range of metastasis also affect the prognosis. Therefore, clinical doctors not only need to understand the pathological type of the tumor but also need to formulate corresponding treatment plans based on the extent of the lesion. Therefore, determining the lesion stage for each patient has practical significance. The most commonly used staging method today is:

　　I stage

　　The tumor is only localized within the testicle and epididymis, and has not broken through the capsule or invaded the spermatic cord, with no lymph node metastasis.

　　II stage

　　The transfer has been confirmed by physical examination and X-ray examination, which can spread to the spermatic cord, scrotum, and inguinal lymph nodes, but has not exceeded the retroperitoneal lymphatic region. The clinical stage IIa is characterized by the inability to palpate the metastatic lymph nodes, while stage IIb is characterized by palpation of abdominal lymph nodes during clinical examination.

　　3. Stage III

　　There are lymph node metastases above the diaphragm or distant metastases. Some researchers also classify distant metastases into stage IV.

　　Second, clinical characteristics

　　Anterior and lateral seminoma is the most common mediastinal malignant embryonal tumor, accounting for 2%-4% of mediastinal tumors, 13% of mediastinal malignant tumors, and 50% of mediastinal malignant germ cell tumors. They are almost all young males, with the peak age of onset between 20-40 years old, located in the anterior mediastinum, and 80% have symptoms.

　　20%-30% of patients are asymptomatic, and the symptoms of symptomatic patients include chest pain, cough, shortness of breath, hemoptysis, etc., and may have drowsiness and weight loss. 10%-20% of patients may have superior vena cava obstruction syndrome. These clinical symptoms are often related to the compression and invasion of the tumor on the mediastinal structure. Some seminomas grow inside the trachea and locally extend to the adjacent mediastinum and lung. Generally, mediastinal seminomas are spread by the lymphatic route, and hematogenous metastasis can also occur, with bones and lungs being the most common sites of metastasis.

　　Chest X-rays often show large anterior mediastinal tumors, and sometimes it can be found that the tumor grows along the trachea. CT usually shows uniform density large masses, 50% can be seen with intrathoracic metastasis or extension beyond the anterior mediastinum that cannot be surgically removed. CT and MRI are helpful in determining the range of the tumor and the invasion of the mediastinal structure. The rate of resection at the first visit is less than 25%.

　　Blood α-FP and β-hCG levels should be measured for all young male patients with anterior mediastinal tumors. Pure seminoma almost always has no increase in AFP, hCG, but 7%-10% have an increase in hCG, but usually not more than 100ng/ml, and AFP does not increase.

　　CA125 may also be a biological marker. Chromosome analysis of tumor tissue can find characteristic isochromosomes on chromosome 12, which is helpful in distinguishing germ cell tumors from other types of tumors.

　　People who consume a high amount of dairy products also have a relatively higher risk of illness. Especially those who consume a lot of cheese, the risk of testicular cancer is 87% higher than that of ordinary people. Therefore, quitting smoking and adjusting bad eating habits are the key to prevention.

　　Tobacco contains carcinogens such as arsenic, and smoking can cause changes in sex hormones, so scientists have long suspected that smoking may be one of the risk factors for disease. Research results show that smoking indeed increases the risk of testicular cancer.

　　1. Early treatment of cryptorchidism, avoiding testicular trauma and excessive sexual activity, has a certain significance for the prevention of seminoma.

　　2. Treatment of cryptorchidism should be carried out between 4-6 years old, and the latest should not exceed 7-11 years old; endocrine treatment can be given for 2 weeks, and orchiopexy should be performed if it is ineffective.

　　Abnormal immune response: Immune reactions that do not appear in normal tissues and cells are expressed in corresponding tumor tissues, all of which are abnormal immune responses. For example, CK appears in various mesenchymal tumors, and desmin can be expressed in hemangioendothelioma and cancer.

　　Epithelioid sarcoma Keratin, Vimentin, CEA, NSE, S-100, and α1-AT can all be positive; Ewing sarcoma Keratin and Vimentin can be positive for a long time, and S-100, NSE, neurofilament (neurofilament, NF), and Leu-7 can all be positive; in addition to α1-AT and α-ACT, Vimentin, Desmin, and NF can also be positive in malignant fibrous histiocytoma. This indicates that the above tumors all have the characteristics of multilineage differentiation.

　　Diet and precautions

　　1. Improve physical fitness. Weakness, overfatigue, insufficient sleep, prolonged mental labor, and other factors can lead to the disease. It is necessary to actively engage in physical exercise, enhance physical fitness, and pay attention to rest, prevent overfatigue, and avoid heavy physical labor.

　　2. Food supplement, mainly dog meat, mutton, sparrow, walnuts, bull penis, sheep kidney, etc.; in addition, zinc-containing foods such as oysters, beef, chicken liver, eggs, peanuts, pork, and chicken, and arginine-containing foods such as yam, ginkgo, tofu skin, cod, sea cucumber, cuttlefish, and octopus, are all helpful for improving physical fitness.

　　3. In daily diet, men should eat more sea cucumber. Sea cucumber is rich in nutrition, benefits the kidneys and strengthens vitality. Regular consumption can be effective for men with few or no sperm. One hundred grams of sea cucumber can be cooked into soup, with seasonings added, and the sea cucumber and soup can be eaten together. Alternatively, yam and lily can be used. The method is to take 250 grams of fresh yam, peel it, and add 25 grams of lily, then simmer in water until the lily is soft. Add 10 grams of rock sugar and eat it cold in three servings. This recipe is especially suitable for men with few sperm and clear deficiency. At the same time, the external kidneys of animals such as sheep, dogs, and cows, including their penises and testicles, can be eaten braised or boiled.

Treatment of testicular seminoma in clinical stage I
Any testicular tumor should first undergo high-testicle orchiectomy, and then the treatment plan should be selected according to the pathological type and clinical stage. Seminoma is highly radiosensitive, and low doses can eliminate metastatic foci without significant radiation damage. For testicular seminoma in clinical stage I, after high-testicle orchiectomy, prophylactic irradiation of the ipsilateral iliac lymph nodes and retroperitoneal lymph nodes should be performed. Linear accelerators with high-energy rays, 60Co, and kilovoltage X-rays can all be used as external irradiation sources. However, it is not necessary to perform high-dose prophylactic irradiation.
Treatment of testicular seminoma in clinical stage II
In clinical stage IIa, the retroperitoneal metastatic lymph nodes are small, and the irradiation field is the same as in clinical stage I; in clinical stage IIb, the metastatic lymph nodes are larger, and the irradiation field should be designed according to the size of the metastatic foci to fully include the lymph nodes. For patients with extensive peritoneal metastases, whole abdominal irradiation should be performed. The dose fractionation of radiotherapy in clinical stage II is the same as in clinical stage I. After the mid-plane dose reaches 25Gy during irradiation, 10Gy of enhanced irradiation should be applied to the metastatic lymph nodes in stage IIa, and the total mid-plane dose should reach 35Gy/4-5 weeks or more; in stage IIb, 15Gy of enhanced irradiation should be applied, and the total dose should reach 40Gy. There is still controversy about whether prophylactic radiotherapy to the mediastinum and left supraclavicular area is needed for testicular seminoma in clinical stage II.
Treatment of clinical stage III and IV testicular seminoma
Clinical stage II, III, and IV testicular seminoma all require comprehensive treatment of radiotherapy and chemotherapy. The treatment method for stage III cases is the same as that for stage II, but the radiation dose for mediastinal and left supraclavicular lymph node metastases should reach 35~40Gy/5~6 weeks. In clinical stage IV cases, there was distant metastasis before treatment, so chemotherapy should be the main treatment, supplemented by radiotherapy to control local lesions, and no prophylactic radiotherapy should be performed. The reasonable treatment is the application of chemotherapy and radiotherapy-chemotherapy, that is, the 'sandwich' technique, which is to perform 3 courses of chemotherapy first, then radiate 35~40Gy/5~6 weeks, and then perform 3~4 courses of chemotherapy.
Testicular seminoma is sensitive to a variety of antitumor drugs. The N-formyl sarcolysin treatment for testicular seminoma, which was first created in China, is taken 150~200mg every night before bedtime, with 6~8g as a course, with a total effective rate of 91.3%, of which 2/3 are completely relieved. Recently, mainly PVB or VAB-6, PVP16 combined chemotherapy is used, and the cure rate in stage III cases reaches 90%.
Radiotherapy
Seminoma
Postoperative radiotherapy can reduce the recurrence rate of the tumor site and para-aortic aorta as well as pelvic lymph nodes, because surgical treatment can remove palpable and visible masses and enlarged lymph nodes, but cannot completely clear the microscopic foci and subclinical lesions around the tumor. Therefore, radiotherapy and surgery can complement each other. By surgically removing the main tumor mass, using moderate dose radiotherapy to eliminate the remaining microscopic foci and subclinical lesions, it can both improve the local control rate and reduce the complications of radiotherapy. For stage II C and III patients, chemotherapy should be combined with radiotherapy under the premise of radiotherapy, which can shrink or even disappear the seminoma with distant metastasis, alleviate symptoms, and extend the life of some patients. Special attention is paid to the important links such as positioning and positioning during treatment, and it is also emphasized that in specific situations such as para-aortic lymph node metastasis and pelvic lymph node metastasis, this key issue should be treated actively and stably. Therefore, it is advocated that patients without distant metastasis or with distant metastasis should be treated actively.