Seminoma surgery
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Seminoma surgery On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Surgery
- Most patients with testicular seminoma will have surgery. The type of surgery depends mainly on the stage of the cancer and how it responds to treatment. When planning surgery, your healthcare team will also consider other factors, such as your serum tumor marker levels and your fertility and the wish to have children.[1]
- The need for surgery in testicular seminoma is to:[1]
- diagnose and help stage the cancer
- completely remove the tumor
- remove tumors that have spread to other parts of the body, such as the lungs
- remove any residual disease
- The following are the types of surgery most commonly used to treat testicular semiono, which include:[1]
- Radical inguinal orchiectomy
- Retroperitoneal lymph node dissection
- Salvage surgery
- Surgery for metastases
Radical Inguinal Orchiectom
- Radical inguinal orchiectomy is the first treatment for any stage of testicular seminoma and it is usually done as part of diagnosis. In some cases, chemotherapy may be given before this surgery is performed.[1]
- Under general anesthesia or spinal (epidural) anesthesia, the surgeon makes a small cut in the groin. The surgeon removes the testicle and spermatic cord from the scrotum through the opening in the groin. The testicle isn’t removed through the scrotum (called transscrotal orchiectomy) because there is a risk that doing so could spread cancer cells into the lymph vessels. Both testicles may be removed (called bilateral orchiectomy) if doctors believe both testicles have cancer in them. The surgery takes about 30 minutes and you can usually go home the same day.
A testicular prosthesis, or artificial testicle, can be placed in the scrotum after an orchiectomy. The prosthesis may be placed at the same time as surgery to remove the testicle, or it can be placed during another surgery done later. Talk to your healthcare team about getting a testicular prosthesis and the best time to place the prosthesis.
Retroperitoneal lymph node dissection
Retroperitoneal lymph node dissection (RPLND) may be done for stage I and II non-seminomas or for any type of testicular cancer that doesn’t respond to chemotherapy.
While you are under general anesthesia, the surgeon makes a large cut in the middle of the abdomen. The surgeon removes lymph nodes from the back of the abdomen (called the retroperitoneum). If the surgeon removes lymph nodes from the same side of the body as the tumour, it is called ipsilateral RPLND. If the surgeon removes lymph nodes from both sides of the body, it is called bilateral RPLND. The surgery takes several hours to complete.
RPLND may be done at the same time as an orchiectomy, or it can be done later during another surgery.
Salvage surgery
Sometimes testicular cncer doesn’t completely respond to chemotherapy that is given after an orchiectomy. The cancer that remains after these primary treatments is called residual disease. Surgery used to remove residual disease is called salvage surgery. If there are high levels of tumour markers in the blood, some men may have salvage surgery to remove residual disease.
Salvage surgery may include a bilateral RPLND if it wasn’t done during a previous surgery.
Surgery for metastases
Surgery may also be used to remove testicular cancer that has spread, or metastasized, to the lung, mediastinum mediastinum The space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes., brain, liver or neck.
References
- ↑ 1.0 1.1 1.2 1.3 Surgery for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/surgery/?region=on. Accessed on March 2, 2016