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Radical removal of the testis
Cancer of the testis is a malignancy of young age. It happens as a solid structure which appears suddenly in the scrotum. It is accidentally discovered either during bathing, taking a shower or a routine urological examination. The lesion is painless. It enlarges fast within few days to weeks.

The affected testis must be removed immediately. The tissues of the other testis must be examined through a biopsy. The patients are then treated according to the type of cells discovered and the stage of the disease. In certain cases the strategy of wait and see have the same results as further surgical treatment.

Cancer of the testis sends its distant cells to the lymph nodes of the great veins of the abdomen. These must be removed in a radical operation called radical abdominal lymphadenectomy. Chemotherapy (combination after Einhorn) may be necessary. The treatment is to 98% completely successful.   



Testicular cancer
Tu = tumor in the testicle
LK = affected lymph nodes around the vessels of the body
Ao = aorta (main artery of the body)
Vc = vena cava (major vein of the body)



Who qualifies for the operation?

Patients in whom an unusual painless hard lesion is discovered in the testis regardless of its size.

How does the operation work?

The operation is done under general anesthesia. The incision is done high in the inguinal region. The field is isolated with special towels. The testicular vessels and spermatic string are identified and prepared free. These structures are clamped carefully using a gentle non traumatic clamp. The testis is then delivered outside the wound. It is carefully inspected and incised. A small part of the lesion is sent for a rapid histological evaluation (frozen section).

If the pathologists declares the tumor, then pedicle of the testis is ligated and the organ is removed otherwise, the clamp must be released and the testis is returned back to its original place. The wound is carefully closed. The other side is opened and a small piece of testicular tissue (biopsy) is taken to exclude hidden cancer of the testis (carcinoma in situ). The wound is closed in layers.




Incision


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Frequently asked questions (FAQ):
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  1. Is it possible to early detect cancer of testis?
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    No, this is not possible but there are some risk persons who have a retained testis inside the abdomen or who have a Penndel testis.
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  2. Is cancer of the testis confined only to the organ?
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    No, in some rare cases the cancer is present only outside the testis (extra gonadal). This is to be discovered by clinical experience and by the immune centigram.
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  3. Can one test for cancer testes in suspected cases?
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    Yes, this can be done throgh the estimation of the markers beta human chorionoc gonadotrophin (ß-HCG) and alpha feto protein ( a-FP).
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  4. Does every painful testis mean the development of cancer?
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    No, testicular cancer is painless. It appears as an accidentally discovered hard mass in the testis.
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  5. What are the precausions one should follow if this is discovered?
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    You must immediately report this finding to the urologist. Operatio must be done as soon as possible, mostely on the next day.
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  6. What are the complications of the operation?
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    These are soiling of the wound with cancer cells, which is avoided through a special technique, infection, hematoma, injury to other structures.
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  7. What is the special technique for removal of cancer testis?
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    This is to remove the accompanying structures including the vas deferens, vessels and facia. This should be done on a high level, at the internal ring of the inguinal canal near the abdominal wall. The procedure is done after confirming the diagnosis through histological examination (frozen section). Tissue samples must be taken from the other testis to exclud the presence of silent malignancy.
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  8. Can this be done on outpatient basis?
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    Yes, this is possible.