Testicular carcinoma

Testis cancer is most commonly discovered because of painless testicular enlargement. Careful examination remains the best non-invasive diagnostic procedure. Accurate definition of pathological type and clinical stage determines management and defines prognosis. Surgical removal of the testis by an inguinal incision after spermatic cord occlusion is mandatory, and scrotal needling or biopsy must be avoided. Seminomas are the most common. When confined to the testis or when spread is limited to a few small retroperitoneal nodes, cure rates of 90% or more are produced by orchiectomy and radiation. Non-seminomatous germinal tumors should be staged surgically using retroperitoneal lymphadenectomy if clinical staging implies minimal tumor spread. Where tumor spread is found, aggressive chemotherapy produces a cure rate of greater than 95%. For advanced disease, chemotherapy is the primary treatment post-orchiectomy.