Testicular cancer surgery: Difference between revisions

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Latest revision as of 15:33, 28 May 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]

Overview

Surgery is the mainstay of treatment for testicular cancer. Radical inguinal orchiectomy is recommended for every patient with testicular cancer for cure and histology.

Surgery

Radical inguinal orchiectomy

Radical inguinal orchiectomy is the first treatment for any stage of testicular cancer and it is usually done as part of diagnosis.^[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 stage I and II non-seminomas or for any type of testicular cancer that doesn’t respond to chemotherapy, testicular cancer with features of malignancy, and nodal metastasis of sex cord stromal of testis.^[2]^[3]^[4]
Retroperitoneal lymph node dissection is the standard surgical approach for Nonseminoma germ cell tumors in primary as well as post-chemotherapy areas.^[5]^[6]

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. If the surgeon removes lymph nodes from the same side of the body as the tumor, it is called ipsilateral RPLND. If the surgeon removes lymph nodes from both sides of the body, it is called bilateral RPLND.

RPLND may be done at the same time as an orchiectomy, or it can be done later during another surgery.

Salvage surgery

Sometimes testicular cancer 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.

References

↑ Nicolai N, Necchi A, Raggi D, Biasoni D, Catanzaro M, Piva L, Stagni S, Maffezzini M, Torelli T, Faré E, Giannatempo P, Pizzocaro G, Colecchia M, Salvioni R (February 2015). "Clinical outcome in testicular sex cord stromal tumors: testis sparing vs. radical orchiectomy and management of advanced disease". Urology. 85 (2): 402–6. doi:10.1016/j.urology.2014.10.021. PMID 25623702.
↑ Mosharafa AA, Foster RS, Bihrle R, Koch MO, Ulbright TM, Einhorn LH, Donohue JP (August 2003). "Does retroperitoneal lymph node dissection have a curative role for patients with sex cord-stromal testicular tumors?". Cancer. 98 (4): 753–7. doi:10.1002/cncr.11573. PMID 12910519.
↑ Silberstein JL, Bazzi WM, Vertosick E, Carver BS, Bosl GJ, Feldman DR, Bajorin DF, Motzer RJ, Al-Ahmadie H, Reuter VE, Sheinfeld J (August 2014). "Clinical outcomes of local and metastatic testicular sex cord-stromal tumors". J. Urol. 192 (2): 415–9. doi:10.1016/j.juro.2014.01.104. PMID 24518791.
↑ Foster RS, Donohue JP (June 2000). "Retroperitoneal lymph node dissection for the management of clinical stage I nonseminoma". J. Urol. 163 (6): 1788–92. PMID 10799183.
↑ Stephenson AJ, Sheinfeld J (2004). "The role of retroperitoneal lymph node dissection in the management of testicular cancer". Urol. Oncol. 22 (3): 225–33, discussion 234–5. doi:10.1016/j.urolonc.2004.04.029. PMID 15271322.
↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."

Template:WikiDoc Sources

[pmid25623702-1] Nicolai N, Necchi A, Raggi D, Biasoni D, Catanzaro M, Piva L, Stagni S, Maffezzini M, Torelli T, Faré E, Giannatempo P, Pizzocaro G, Colecchia M, Salvioni R (February 2015). "Clinical outcome in testicular sex cord stromal tumors: testis sparing vs. radical orchiectomy and management of advanced disease". Urology. 85 (2): 402–6. doi:10.1016/j.urology.2014.10.021. PMID 25623702.

[pmid12910519-2] Mosharafa AA, Foster RS, Bihrle R, Koch MO, Ulbright TM, Einhorn LH, Donohue JP (August 2003). "Does retroperitoneal lymph node dissection have a curative role for patients with sex cord-stromal testicular tumors?". Cancer. 98 (4): 753–7. doi:10.1002/cncr.11573. PMID 12910519.

[pmid24518791-3] Silberstein JL, Bazzi WM, Vertosick E, Carver BS, Bosl GJ, Feldman DR, Bajorin DF, Motzer RJ, Al-Ahmadie H, Reuter VE, Sheinfeld J (August 2014). "Clinical outcomes of local and metastatic testicular sex cord-stromal tumors". J. Urol. 192 (2): 415–9. doi:10.1016/j.juro.2014.01.104. PMID 24518791.

[pmid10799183-4] Foster RS, Donohue JP (June 2000). "Retroperitoneal lymph node dissection for the management of clinical stage I nonseminoma". J. Urol. 163 (6): 1788–92. PMID 10799183.

[pmid15271322-5] Stephenson AJ, Sheinfeld J (2004). "The role of retroperitoneal lymph node dissection in the management of testicular cancer". Urol. Oncol. 22 (3): 225–33, discussion 234–5. doi:10.1016/j.urolonc.2004.04.029. PMID 15271322.

[6] "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."

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@@ Line 1: / Line 1: @@
-{{CMG}}
+__NOTOC__
+{{CMG}}; {{AE}} {{G.D.}}, {{SC}}
 {{Testicular cancer}}
+==Overview==
+[[Surgery]] is the mainstay of treatment for testicular cancer. Radical [[inguinal]] [[orchiectomy]] is recommended for every [[patient]] with testicular cancer for [[cure]] and [[histology]].
+==Surgery==
+'''Radical inguinal orchiectomy'''
+* Radical [[inguinal]] [[orchiectomy]] is the first treatment for any stage of testicular cancer and it is usually done as part of [[diagnosis]].<ref name="pmid25623702">{{cite journal |vauthors=Nicolai N, Necchi A, Raggi D, Biasoni D, Catanzaro M, Piva L, Stagni S, Maffezzini M, Torelli T, Faré E, Giannatempo P, Pizzocaro G, Colecchia M, Salvioni R |title=Clinical outcome in testicular sex cord stromal tumors: testis sparing vs. radical orchiectomy and management of advanced disease |journal=Urology |volume=85 |issue=2 |pages=402–6 |date=February 2015 |pmid=25623702 |doi=10.1016/j.urology.2014.10.021 |url=}}</ref>
+* 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|Retroperitoneal lymph node dissection]] (RPLND) may be done for stage I and II [[Nonseminoma|non-seminomas]] or for any type of testicular cancer that doesn’t respond to [[chemotherapy]], testicular cancer with features of [[malignancy]], and [[Nodal (protein)|nodal]] [[metastasis]] of [[sex cord]] [[stromal]] of [[testis]].<ref name="pmid12910519">{{cite journal |vauthors=Mosharafa AA, Foster RS, Bihrle R, Koch MO, Ulbright TM, Einhorn LH, Donohue JP |title=Does retroperitoneal lymph node dissection have a curative role for patients with sex cord-stromal testicular tumors? |journal=Cancer |volume=98 |issue=4 |pages=753–7 |date=August 2003 |pmid=12910519 |doi=10.1002/cncr.11573 |url=}}</ref><ref name="pmid24518791">{{cite journal |vauthors=Silberstein JL, Bazzi WM, Vertosick E, Carver BS, Bosl GJ, Feldman DR, Bajorin DF, Motzer RJ, Al-Ahmadie H, Reuter VE, Sheinfeld J |title=Clinical outcomes of local and metastatic testicular sex cord-stromal tumors |journal=J. Urol. |volume=192 |issue=2 |pages=415–9 |date=August 2014 |pmid=24518791 |doi=10.1016/j.juro.2014.01.104 |url=}}</ref><ref name="pmid10799183">{{cite journal |vauthors=Foster RS, Donohue JP |title=Retroperitoneal lymph node dissection for the management of clinical stage I nonseminoma |journal=J. Urol. |volume=163 |issue=6 |pages=1788–92 |date=June 2000 |pmid=10799183 |doi= |url=}}</ref>
+* [[Retroperitoneal]] [[lymph node]] [[dissection]] is the standard surgical approach for [[Nonseminoma]] [[germ cell]] [[tumors]] in primary as well as post-[[chemotherapy]] areas.<ref name="pmid15271322">{{cite journal |vauthors=Stephenson AJ, Sheinfeld J |title=The role of retroperitoneal lymph node dissection in the management of testicular cancer |journal=Urol. Oncol. |volume=22 |issue=3 |pages=225–33; discussion 234–5 |date=2004 |pmid=15271322 |doi=10.1016/j.urolonc.2004.04.029 |url=}}</ref><ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref>
-==Overview==
+* 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]]. If the [[surgeon]] removes [[lymph nodes]] from the same side of the body as the [[tumor]], it is called ipsilateral RPLND. If the [[surgeon]] removes [[lymph nodes]] from both sides of the [[Body|body,]] it is called bilateral RPLND.
-==Surgical options==
+* RPLND may be done at the same time as an [[orchiectomy]], or it can be done later during another [[surgery]].
-===Orchiectomy===
-While it may be possible, in some cases, to remove testicular cancer tumors from a testis while leaving the testis functional, this is almost never done, as more than 95% of testicular tumors are [[malignant]].  Since only one testis is typically required to maintain fertility, hormone production, and other male functions, the afflicted testis is almost always removed completely in a procedure called [[inguinal orchiectomy]]. (The testicle is almost never removed through the scrotum; an incision is made beneath the belt line in the inguinal area.)  Most notably, since removing the tumor alone does not eliminate the precancerous cells that exist in the testis, it is usually better in the long run to remove the entire testis to prevent another tumor.  A plausible exception could be in the case of the second testis later developing cancer as well.
+'''Salvage surgery'''
-===Retroperitoneal Lymph Node Dissection (RPLND)===
+* Sometimes testicular cancer 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 therapy|salvage]] [[surgery]].
-In the case of [[nonseminoma]]s that appear to be stage I, surgery may be done on the [[Retroperitoneum|retroperitoneal]]/[[Paraaortic lymph node|Paraaortic]] [[lymph node]]s (in a separate operation) to accurately determine whether the cancer is in stage I or stage II and to reduce the risk that [[malignant]] testicular cancer cells that may have [[Metastasis|metastasized]] to lymph nodes in the lower abdomen.  This surgery is called [[Retroperitoneal Lymph Node Dissection]] (RPLND).  However, this approach, while standard in many places, especially the United States, is falling out of favor due to costs and the high level of expertise required to perform the surgery.
+==References==
+{{Reflist|2}}
-Many patients are instead choosing surveillance, where no further surgery is performed unless tests indicate that the cancer has returned. This approach maintains a high cure rate because of the growing accuracy of surveillance techniques.
+{{WikiDoc Help Menu}}
+{{WikiDoc Sources}}
-Lymph node surgery may also be performed after chemotherapy to remove masses left behind, particularly in the cases of advanced initial cancer or large [[nonseminoma]]s.
+[[Category:Disease]]
+[[Category:Andrology]]
+[[Category:Types of cancer]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Urology]]

Testicular cancer surgery: Difference between revisions

Latest revision as of 15:33, 28 May 2019

Overview

Surgery

References

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