tend to be dominant in determining the tumor’s
behavior. The distinction is important because the
types have different patterns of aggressiveness
(rate and way in which the tumor grows), METAS-
TASIS, and responsiveness to treatment.
Symptoms and Diagnostic Path
The most common symptom of testicular cancer is
a painless though sometimes tender lump or
swelling in the SCROTUM. The man may discover
the lump or swelling during TESTICULAR SELF-EXAMI-
NATION(TSE) or coincidentally, or the doctor may
find it during ROUTINE MEDICAL EXAMINATION. Testic-
ular cancer also may cause few symptoms until it
has grown and spread outside the testicle, such as
to organs in the abdomen. In such circumstances,
symptoms may be more generalized and include
low pelvic or low back heaviness or pressure,
fatigue, and overall sense of not feeling well
(malaise).344 The Reproductive System
BASIC STAGING OF TESTICULAR CANCERStage Meaning Treatment Options
stage 0/carcinoma cancer remains contained in the cells of radical inguinal ORCHIECTOMY
in situ their origin
stage 1 cancer remains confined to a local tumor radical inguinal orchiectomy
in one testicle seminoma: inguinal and retroperitoneal LYMPH NODE
irradiation
nonseminoma: retroperitoneal lymph node dissection or
two cycles of chemotherapy
stage 2 nonbulky cancer has spread to retroperitoneal LYMPH radical inguinal orchiectomy
nodes and nodes are 2 inches or smaller seminoma: inguinal and retroperitoneal lymph node
irradiation
nonseminoma: retroperitoneal lymph node dissection,
then two cycles of chemotherapy
stage 2 bulky cancer has spread to retroperitoneal lymph radical inguinal orchiectomy
nodes and nodes are larger than 2 inches seminoma: three cycles of chemotherapy
nonseminoma: three or four cycles of chemotherapy
stage 3 nonbulky cancer has spread to lymph nodes outside radical inguinal orchiectomy
the abdomen and to the LUNGSthough all seminoma: three or four cycles of chemotherapy;
metastasized tumors are^3 ⁄ 4 inch or smaller RADIATION THERAPYfor BRAIN METASTASIS
nonseminoma: three or four cycles of chemotherapy;
surgery to remove any remaining metastatic tumors
stage 3 bulky cancer has spread to lymph nodes outside radical inguinal orchiectomy
the abdomen and nonlung sites such as the seminoma: four cycles of chemotherapy; radiation
LIVERor brain, and some metastasized tumors therapy for brain metastasis
are larger than^3 ⁄ 4 inch nonseminoma: four cycles of chemotherapy; surgery to
remove any remaining metastatic tumors clinical trials
stage 4/recurrent cancer has returned after treatment surgery for small, isolated metastases
high-DOSEchemotherapy