Diagnosis and treatment of testicular tumors

Abstract

1. 1. Tumors of the testis are relatively uncommon but are among the most malignant of the body. In patients from twenty to thirty-five years of age, they comprise the most common form of malignancy encountered, and reap a heavy toll of life. At least four of ten of these young adult males will die of the disease. This fact emphasizes the importance of early detection and prompt therapy. 2. 2. The germinal tumors comprise more than 95 per cent of all testicular tumors and include the most malignant types. Hormonal activity is present in the majority, as demonstrated by gonadotrophin excretion, but physical changes are unusual. There is poor correlation between the histologic picture and the rate of gonadotrophin excretion. Hormonal assays of the urine, however, are of definite value in indicating response to therapy and as a guide to prognosis. 3. 3. Early diagnosis is imperative and offers the best opportunity for reducing the present excessive mortality. An average of five months elapsed in this series between the onset of symptoms and the institution of therapy. This delay was due in part (25 per cent) to an erroneous diagnosis at the time of initial examination. One should acquaint himself with the anatomy of the scrotum and be able to palpate its contents accurately. Testicular tumors should be considered surgical emergencies. 4. 4. Seminomas are radiosensitive and one can expect a cure rate of over 90 per cent by orchiectomy and radiation alone. However, the microscopic sections should be carefully studied for the presence of other elements and if doubt exists, lymphadenectomy is indicated. 5. 5. The treatment of the radioresistant tumors (embryonal carcinomas, teratocarcinomas and teratomas) should include retroperitoneal lymphadenectomy, and bilateral dissection should be performed in all cases. 6. 6. The transperitoneal approach to the retroperitoneal space, in our opinion, offers definite advantages over other incisions. It provides good access to the critical area around the renal vessels on both sides and permits simultaneous bilateral resection.