Seminoma surgery
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Seminoma Microchapters |
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Treatment |
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Seminoma surgery On the Web |
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American Roentgen Ray Society Images of Seminoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Radical inguinal orchiectomy is the first treatment for any stage of testicular seminoma and it is usually done as part of diagnosis.
Surgery
- Surgery is usually reserved for majority of patients.The feasibility of surgery depends on the stage of seminomsat diagnosis.
- The type of surgery depends mainly on the stage of the cancer and how it responds to treatment..[1]
- The need for surgery in testicular seminoma is to:
- 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 Orchiectomy
- 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.
- Under general anesthesia or spinal (epidural) anesthesia, the surgeon makes a small cut in the groin, the testicle and spermatic cord are removed 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 of disseminating the cancer cells into the lymph vessels. Both the testicles may be removed (called bilateral orchiectomy), if both the testicles are involved.[1]
- 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.
Retroperitoneal Lymph Node Dissection
- Retroperitoneal lymph node dissection (RPLND) may be done for any type of seminoma that doesn’t respond to chemotherapy.[1]
- Under general anesthesia, the ipsilateral retroperitoneal lymph nodes are removed. If lymph nodes from both sides of the body are removed , it is called bilateral RPLND.
- RPLND may be done at the same time as orchiectomy, or it can be done later during another surgery.[1]
Salvage Surgery
- Sometimes, seminoma doesn’t completely respond to chemotherapy 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 tumor markers in the blood, salvage surgery may be performed to remove residual disease.[1]
- Salvage surgery may include a bilateral RPLND, if it wasn’t done during a previous surgery.[1]
Surgery for Metastases
- Surgery may also be used to remove seminoma that has metastasized to the lung, mediastinum, brain, liver, or neck.[1]