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(i.e., embryonic-like) cells, a common characteristic of many cancers.Scrotal ultrasonography can readily determine whether a scrotal mass is intra- or extra-testicular in location and solid or cystic in nature. Cystic testicular lesions are usually non-cancerous and known as epidermoid cysts. If the lesion is intra-testicular, the entire testicleis often surgically removed and biopsied. In fact, whenever possible, surgeons try to removethe entire tumor together with the testicle and spermatic cord (i.e., radical orchiectomy).Testicular cancerVas deferensEpididymisTestisDISEASESUMMARYFIGURE74.1 Illustration showing a cancerous tumor on the surface of the testicle. (Image provided by theAnatomical Chart Company).
DS74-5Case Study 74 ■Testicular CancerSince the majority of testicular tumors are cancerous and manipulation of the testis maycause metastasis, sampling of the tumor for biopsy is often avoided. However, in rare caseswhen the diagnosis is uncertain, a small sample of the tumor may be removed first and biop-sied. If an inguinal node is enlarged, a biopsy of the lymph node is common practice. Once the microscopic diagnosis of testicular cancer has been established, clinical stag-ing of the disease (i.e., determining the extent of spread) is accomplished primarily by chest,abdominal, and pelvic computed tomography (CT) scanning. As with many cancers, prog-nosis is related to the clinical stage of the disease. The stage of testicular cancer is based onthe extent of local tissue invasion outside of the testis (e.g., spermatic cord), metastasis toregional and non-regional lymph nodes, and distant metastasis. With stage I disease, thetumor is confined to the testicle. At stage II, spread has occurred to retroperitoneal lymphnodes below the diaphragm. With stage III disease, dissemination of cancerous cells outsideof the retroperitoneal nodes or above the diaphragm has taken place. Disease SummaryFigure 74.2 illustrates the three clinical stages of testicular cancer.Early diagnosis of testicular cancer is critical because any delay in seeking medicalattention may result in presentation with a more advanced stage of the disease and decreasedeffectiveness of treatment. The American Cancer Society strongly encourages every youngadult male to examine his testicles monthly as a means of early detection. The examinationshould be done after a warm bath or shower, when the scrotal skin is relaxed. Each testicleshould be examined with the fingers of both hands and by rolling the testis between thethumb and fingers. If any lump or enlargement is noticed, it should be brought immediatelyto the attention of a healthcare provider.Appropriate TherapyThe initial treatment of choice for all testicular cancers is radical orchiectomy (i.e., sur-gical removal of the entire testis) through an inguinal incision.Recommendations for fur-ther therapy are based on microscopic results of the tumor (which determine the specific