Staging procedures and the role of surgery in testicular cancer

The conventional staging system for testicular cancer is inadequate in discriminating between varying degrees of local, nodal, and pulmonary disease. This staging system which uses conventional tests including lymphangiogram, iv pyelogram, and inferior venacavogram has been demonstrated to have a 35%--53% error rate in distinguishing between stages I and II cancer based upon retroperitoneal node dissection. A surgicopathologic staging system has been proposed which improves upon the conventional staging system for testicular cancer. This clinical and surgicopathologic staging system has been proposed based on determination of serum alphafetoprotein and human chorionic gonadotropin before and/or after orchiectomy and lymphadenectomy with a low staging error. The conventional surgical management of testicular cancer and the current status of the National Cancer Institute prospective randomized clinical trial assessing the role of intensive chemotherapy with or without cytoreductive surgery in poor-risk bulky stage III testicular cancer are discussed.