Inguinal (radical) orchiectomy: The best removal of the primary lesion is achieved by clamping the spermatic cord close to the internal ring and removing the entire testis. In rare cases, exploration and frozen biopsy may be required. The scrotal approach should be avoided in terms of contamination of the inguinal lymphatics. After diagnosis, standard AC X-ray and retroperitoneal CT should be taken, considering possible metastasis areas.
Seminoma: The majority of seminomas are local and very sensitive to radiotherapy. In patients with stage 1 seminoma, follow-up is recommended after radical orchiectomy. In low-stage patients, the cure rate reaches 99%. Seminoma is also sensitive to combinations of platinum-containing chemotherapy and chemotherapy should be administered as salvage therapy after radiotherapy. In more advanced stages and in large masses that cause AFP elevation, chemotherapy should be administered first. Often, masses undergo fibrosis after chemotherapy.
Nonseminomatous germ cell tumor: Treatment alternatives in patients with stage 1 disease are follow-up, chemotherapy or RPLND. In early-stage disease, 75% of patients recover with orchiectomy alone. The major long-term complications of RPLND are ejaculation problems and infertility due to damage to the sympathetic nerve fibers. With the developed surgical techniques, it is tried to minimize the morbidity rate. Combinations of platinum-containing chemotherapy in patients with high-grade large retroperitoneal masses have revolutionized the treatment of these tumors. Surgery should be performed for the residual mass after chemotherapy.
All patients should be kept under regular follow-up. Patients should undergo careful physical examination for possible lymph node metastases and recurrent intra-abdominal mass. Complete blood count and tumor marker levels (AFP, βHCG, LDH) should be checked in laboratory studies. Chest radiogram should be taken for lung metastases and, less frequently, intra-abdominal recurrence should be investigated with abdominal CT.
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