Radical inguinal orchiectomy for testicular germ cell tumors

INTRODUCTION

Testicular cancers, 95 percent of which are germ cell tumors, have become one of the most curable solid neoplasms because of remarkable treatment advances that began in the late 1970s. Prior to that time, testicular cancer accounted for 11 percent of all cancer deaths in men between the ages of 25 to 34, and the five-year survival rate was 64 percent [1]. Now, the five-year survival rate is over 95 percent for both seminoma and nonseminomatous germ cell tumors (NSGCTs) (table 1) [2], and testicular cancer is responsible for fewer than 400 deaths annually in the United States [3].

These improvements in outcome are related to a better understanding of the natural history of testicular tumors, improved staging and surgical techniques, the use of tumor markers to guide patient management, and the introduction of effective platinum-based combination chemotherapy [1,4,5]. The consistently high cure rates in early stage disease have resulted in a shift in focus toward reducing treatment-related effects on reproductive function, as well as the toxicities associated with chemotherapy and radiation. (See "Treatment-related toxicity in men with testicular germ cell tumors".)

Radical orchiectomy for the diagnosis and treatment of men with suspected testicular cancer is discussed here. An overview of the management of testicular cancer is presented separately. (See "Overview of the treatment of testicular germ cell tumors".)

SURGICAL TREATMENT OF THE TESTIS

The decision to proceed with operative intervention in a man with a suspected testicular cancer is made after careful consideration of all available data, including the clinical findings, imaging studies, and serum tumor markers. Although frequently used to support a clinical suspicion of testicular cancer, scrotal ultrasound of a testicular mass cannot replace surgical and histologic examination of the testis based upon radical inguinal orchiectomy. (See "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors".)

Radical inguinal orchiectomy — Radical inguinal orchiectomy with high ligation of the spermatic cord at the level of internal ring is the procedure of choice for suspected testicular cancer.