Surgery for Testicular Cancer

Surgeon being handed something
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When a lump has been discovered in a testis and confirmed using ultrasound, the next step is typically removal of the testis by surgery. This is different from most other cancer types that typically require a biopsy to confirm the cancer prior to considering surgery. As examples, breast lumps are biopsied using needles and colon cancers are biopsied during colonoscopies before surgery is undertaken.

Testicular cancer is unique in that the actual diagnosis is almost always obtained by surgical removal of the testicle in question. This is done for several reasons: #1 There is evidence that penetrating the scrotum, with a needle or any other surgical instrument, can result in worse outcomes as it possibly affects lymphatic drainage and thus affecting how the cancer may spread. In other words, it may result in higher levels of recurrence and spread of the cancer. #2 Surgical removal of the testicle is always part of treatment if a cure is to be obtained. Even when the cancer has spread to other locations, such as the lungs and nodes, the testicle still needs to be removed because chemotherapy has difficulty accessing testicular tissues from the bloodstream.

Before Surgery

Before the surgery takes place, several things should occur. First of all, special blood tests known as tumor markers are drawn and assessed.

It is important to have a CT scan of the abdominal/pelvic region to assess whether any lymph nodes are involved with cancer. However, this can happen after surgery as the cancerous testicle needs to be removed regardless of whether nodes are involved or not. Oftentimes a CT scan of the chest or a chest x-ray are done to assess for any possible spread to the lungs.

Before surgery, it needs to be decided whether a prosthesis (i.e. fake testicle) is to be used in place of the cancerous testicle. This is just for cosmetic purposes and serves no functional purpose otherwise.

Sperm banking is another process which should be considered based on the desire to maintain fertility for the future. Fertility may or may not be affected by orchiectomy. Typically the remaining testicle is able to compensate following surgery, but this should be discussed with the surgeon prior to undergoing surgery.

The Surgery Itself: The Inguinal Radical Orchiectomy

To understand how the surgery works, it's helpful to understand the anatomy of the region. The testicle is suspended by a structure known as the spermatic cord. The spermatic cord is comprised of blood vessels, nerves as well as the vas deferens, also called ductus deferens, which carry sperm from the testicle. During normal fetal development, the testicles form in the abdomen and descend down the inguinal canal into the scrotum. An incision is made in the lower abdomen and the testicle is pulled back through the inguinal canal by the spermatic cord. The cord is clamp and severed high above the testicle and the incisions are then closed.

Post-Surgery Recovery and Recommendations

Bed rest may be recommended for the first 24 hours following surgery. Testicular support is typically accomplished by using supportive undergarments, such as a jock strap, for several days following surgery. Return to regular activity can typically occur within about 2 to 3 weeks following surgery.

Complications from surgery are rare and are typically limited to bleeding, both in the scrotum as well as the region above it, as well as infections.

Alternatives to Traditional Orchiectomy

There are few alternatives to the radical orchiectomy as outlined above.

One alternative, which is done only in select cases, is known as the partial orchiectomy. This involves removing just the cancerous part of the testicle. This is done in very select cases to preserve fertility. This may be an option if there is only one testicle, or if both testicles are affected with cancer.

What Next?

Further treatment will be based on the exact type and stage of the cancer .