1. Testicular Tumours Part 2
Vinod Jain

2. Clinical Staging (Boden and Gibbs – 1971)
Stage I (A) – confined to testis with no spread through capsule or spermatic cord
Stage II (B) – Clinical or radiological evidence of spread beyond testis but with in regional L.N.
B1 -<2cm
B2 -2-5cm
B3 - >5cm
Stage III (C) - Disseminated above diaphragm / visceral disease

3. Treatment Modalities Stage wise protocol Care of fertility Surgery
Radiotherapy
Chemotherapy
Stage wise protocol
Care of fertility

4. Treatment Modalities – Surgery
Radical orchiectomy
Organ sparing orchiectomy
Hemiscrotectomy
RPLND (retroperitoneal lymph node dissection - Boundaries)
Modified RPLND with surveillance - modification
Testicular implants (Silicon or saline)

5. Treatment Modalities – Radiotherapy
Tele-Cobalt RT – 2500 cGy within 3 weeks to paraortic, precaval, bilateral common iliac and external iliac Inguinal – depending on indication

6. Treatment Modalities – Chemotherapy
First line – BEP – Bleomycin, Etoposide and cis-Platinum
Second line – Ifosfamide + BEP = Salvage CT
Third line – High dose CT with autologous Bone Marrow transplantation

7. Stage wise protocol – Seminoma (SGCT)
Stage I- Radical orchiectomy cGy RT in para aortic area
Stage II/ B1, B2 – Radical orchiectomy + RT – para aortic + paracaval + Bilat common iliac + ipsilateral ext. iliac.
If previous opn/orchiopexy – contralateral inguinal LN with testicular shield
Stage II/B3 and stage III – CT x 4 cycles (contd.)

8. Residual retroperitoneal LN
CT x 4 cycles
Residual retroperitoneal LN
Complete Remission
Follow up
<3 cm
>3 cm
Follow up CT
Surgical
excision / RT

9. Stage wise protocol – Non Seminoma (NSGCT)
Stage I- Radical orchiectomy + RPLND or modified RPLND with surveillance
Stage II/B1, B2 – Radical orchiectomy + RPLND (Boundaries)
II/B1 – No CT
II/B2 – CT x 2 cycles
Stage II/B3 and III – CT (BEP) x 4 cycles

10. CT (BEP) x 4 cycles Always Excision Tumour marker increased
Tumour marker normalizes
Salvage CT (BEP) + ifosfamide
Residual mass
No residual Mass
Remission
No remission
Always Excision
Follow up
Follow up
Autologous BM
transplant + high
dose CT or stem
cell support

11. Follow Up schedule 3 monthly x 2 years – then
Yearly
Look for
Other testis
Abdomen / L.N.
Haematological Examination
Tumour markers
Chest X-ray
CT scan

12. (Partial orchiectomy is done)
Organ sparing surgery
Younger age with organ confined tumour of <2 cm size
Polar tumours occurring in solitary testis or with contra-lateral tumour
(Partial orchiectomy is done)

13. Let us revise Classification Incidence Etiology Spread of tumour
Clinical Staging
Clinical features
Differential Diagnosis
Investigations
Treatment
Follow up schedule