The management of testicular cancer involves a multidisciplinary approach tailored to the histology and stage of the disease.
The management of testicular cancer involves a multimodal approach, including surgery, chemotherapy, and radiotherapy, tailored to the type and stage of the disease.
The primary treatment for most patients with a testicular mass suspicious for malignancy is a radical inguinal orchiectomy, which is both diagnostic and therapeutic.
Radical inguinal orchiectomy is the primary treatment for most patients presenting with a testicular mass suspicious for malignancy.
Further management depends on the histology (seminoma vs. nonseminoma) and stage of the disease.
1. Stage I Disease: Seminoma: Options include active surveillance, adjuvant radiotherapy, or single-dose carboplatin chemotherapy.
Surveillance is often preferred due to excellent outcomes and minimal toxicity.
Nonseminoma: Options include active surveillance, nerve-sparing retroperitoneal lymph node dissection (RPLND), or adjuvant chemotherapy (typically one cycle of bleomycin, etoposide, and cisplatin [BEP]).
2. Stage II Disease: Stage IIA/IIB Seminoma: For lymph nodes ≤3 cm, either radiotherapy or multi-agent cisplatin-based chemotherapy is recommended.
For lymph nodes >3 cm, chemotherapy is preferred.
• Stage IIA/IIB Nonseminoma:
Treatment options include RPLND or multi-agent chemotherapy, depending on the extent of lymph node involvement and patient preference.
Advanced Disease: Stage III and Metastatic Disease: Cisplatin-based combination chemotherapy is the mainstay of treatment.
Post-chemotherapy surgical resection of residual masses may be necessary.
Active surveillance involves regular follow-up with physical exams, tumor markers, and imaging to detect recurrences early.
This approach is particularly suitable for patients with stage I disease who prefer to avoid the immediate side effects of adjuvant therapy.
Chemotherapy can lead to metabolic syndrome, hypogonadism, and secondary malignancies, while radiotherapy carries risks of gastrointestinal complications and secondary cancers.
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