Surgery is necessary in all cases because the removal of the affected testicle is required for diagnosis. The use of further surgery, radiation and chemotherapy depends on the stage of the disease.
Surgery For local tumors, the first step is to remove the testis, epididymis and spermatic cord
(radical orchiectomy), performed by an inguinal approach, meaning that it is removed through the groin. This is never done through an incision in the scrotum because that would open up new lymph drainage areas to the groin.
When the cancer diagnosis is confirmed after orchiectomy, another operation is done to remove the lymph nodes in the back of the abdomen. This standard operation is known as a retroperitoneal lymph node dissection. Although recent studies suggest that in highly selected cases—those with small (T1) tumors and without spermatic cord or lymphatic and blood vessel invasion or embryonal components—simple surveillance can be used after the orchiectomy (in other words, watch until a relapse occurs), retroperitoneal lymph node dissection remains the "gold standard" for treatment.
New surgical techniques have resolved many quality-of-life issues raised by this operation. The procedure is now much more acceptable, since the ability to have children is preserved in over 60 percent of cases. What is needed is more precise information to determine which tumors will ultimately relapse and then to evaluate by means of clinical trials the question of which patients need surgery or chemotherapy.
