Skip to main content
SpringerLink
Log in

Testicular Cancer- Clinical Features, Staging and Surgical Management

  • Chapter
  • First Online:
Urological Oncology

  • 1663 Accesses

Abstract

The majority of men with testicular germ cell tumours present with a painless testicular mass typically between 20 and 40 years of age. Staging includes measurement of serum tumour markers AFP, ß-hCG and LDH and imaging by computed tomography of the chest, abdomen and pelvis. Primary management consists of extirpation of the tumour-bearing testis and its cord (radical orchiectomy) through the inguinal approach. In doubtful cases intraoperative frozen section analysis may be considered. An organ sparing approach can be carefully considered in men with synchronous or metachronous bilateral TGCT or a tumour in solitary testicle, but this awaits wider acceptance. A contralateral testicular biopsy to rule out testicular intraepthelial neoplasia is recommended in high-risk patients (testicular volume <12 ml, age <30 years, history of cryptorchidism). In clinical stage I nonseminomatous TGCT, a risk adapted approach is recommended with active surveillance, primary chemotherapy with 2 cycles or nerve sparing retroperitoneal lymph node dissection (RPLND). Low volume metastatic disease (clinical stages IIA-B) associated with elevated tumour markers are best managed by primary systemic chemotherapy whereas patients with negative markers might be approached by active surveillance or by nerve sparing RPLND. Postchemotherapy RPLND remains an integral part of the multimodality treatment of advanced testicular cancer. Small indeterminate lesions less than 1 cm in diameter might be managed by active surveillance in men with good prognosis. In all other cases, all residual retroperitoneal lesions should be completely resected.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bosl GH, Goldman A, Lange PH, et al. Impact of delay in diagnosis on clinical stage of testicular cancer. Lancet. 1981;2(8253):970–3.

    Article  CAS  PubMed  Google Scholar 

  2. Nikzas S, Champion AE, Fox M. Germ cell tumors of testis: prognostic factors and results. Eur Urol. 1990;18:242–7.

    CAS  PubMed  Google Scholar 

  3. Krege S, Albers P, Heidenreich A. The role of tumour markers in diagnosis and management of testicular germ cell tumours. Urologe A. 2011;50(3):313–21.

    Article  CAS  PubMed  Google Scholar 

  4. Krege S, Beyer J, Souchon R, Albers P, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol. 2008;53(3):478–96.

    Article  PubMed  Google Scholar 

  5. Albers P, Albrecht W, Algaba F, et al. EAU guidelines on testicular cancer: 2011 update. Eur Urol. 2011;60(2):e9–18.

    Article  Google Scholar 

  6. Barentsz J, Takahashi S, Oyen W, et al. Commonly used imaging techniques for diagnosis and staging. J Clin Oncol. 2006;24:3234–44.

    Article  CAS  PubMed  Google Scholar 

  7. White PM, Adamson DJA, Howard GCW, et al. Imaging of the thorax in the management of germ cell testicular tumours. Clin Radiol. 1999;54:207–11.

    Article  CAS  PubMed  Google Scholar 

  8. Meyer CA, Conces DJ. Imaging of intrathoracic metastases of nonseminomatous germ cell tumors. Chest Surg Clin N Am. 2002;12:717–38.

    Article  PubMed  Google Scholar 

  9. Kreydin EI, Barrisford GW, Feldman AS, Preston MA. Testicular cancer: what the radiologist needs to know. Am J Roentgenol. 2013;200(6):1215–25.

    Article  Google Scholar 

  10. de Wit M, Brenner W, Hartmann M, et al. [18F]-FDG-PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol. 2008;19(9):1619–23.

    Article  PubMed  Google Scholar 

  11. Huddart RA, O’Doherty MJ, Padhani A, Rustin GJ, et al. NCRI Testis Tumour Clinical Study Group. 18fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high-risk, clinical stage I nonseminomatous germ cell tumors: preliminary report of MRC Trial TE22 – the NCRI Testis Tumour Clinical Study Group. J Clin Oncol. 2007;25(21):3090–5.

    Article  PubMed  Google Scholar 

  12. Sobin LH, Wittekind CH, editors. UICC: TNM classification of malignant tumours. 7th ed. New York: Wiley-Liss; 2010.

    Google Scholar 

  13. International Germ Cell Cancer Collaborative Group (IGCCCG). The International Germ Cell Consensus Classification: a prognostic factor based staging system for metastatic germ cell cancer. J Clin Oncol. 1997;15:594–603.

    Google Scholar 

  14. Holstein AF, Orlandini GE, Moller R. Distribution and fine structure of the lymphatic system in the human testis. Cell Tissue Res. 1979;200(1):15–27.

    Article  CAS  PubMed  Google Scholar 

  15. Husband JE, Koh D-M. Chapter 19: Testicular germ cell tumours. In: Husband JE, Reznek RH, editors. Imaging in oncology. 2nd ed. London: Taylor & Francis; 2004. p. 401–27.

    Google Scholar 

  16. Holtl L, Pescel R, Knapp R, et al. Primary lymphatic metastatic spread in testicular cancers occurs ventral to the lumbar vessels. Urology. 2002;59:114–8.

    Article  CAS  PubMed  Google Scholar 

  17. Williams MP, Cook JV, Duchesne GM. Psoas nodes: an overlooked site of metastasis from testicular tumours. Clin Radiol. 1989;40:607–9.

    Article  CAS  PubMed  Google Scholar 

  18. Ondrus D, Hornak M, Breza J, et al. Delayed orchiectomy after chemotherapy in patients with advanced testicular cancer. Int Urol Nephrol. 2001;32:665–7.

    Article  CAS  PubMed  Google Scholar 

  19. Simmonds PD, Mead GM, Lee AHS, et al. Orchiectomy after chemotherapy in patients with metastatic testicular cancer. Cancer. 1995;75:1018–24.

    Article  CAS  PubMed  Google Scholar 

  20. Leibovitch I, Little JS, Foster RS, et al. Delayed orchiectomy after chemotherapy for metastatic nonseminomatous germ cell tumors. J Urol. 1996;155:952–4.

    Article  CAS  PubMed  Google Scholar 

  21. Elert A, Olbert P, Hegele A, et al. Accuracy of frozen section examination of testicular tumors of uncertain origin. Eur Urol. 2002;41:290–3.

    Article  PubMed  Google Scholar 

  22. Leroy X, Rigot JM, Aubert S, et al. Value of frozen section examination for the management of nonpalpable incidental testicular tumors. Eur Urol. 2003;44:458–60.

    Article  PubMed  Google Scholar 

  23. Weissbach L. Organ preserving surgery of malignant germ cell tumors. J Urol. 1995;153:90–3.

    Article  CAS  PubMed  Google Scholar 

  24. Heidenreich A, Weissbach L, Höltl W, et al. German Testicular Cancer Study Group. Organ sparing surgery for malignant germ cell tumor of the testis. J Urol. 2001;166:2161–5.

    Article  CAS  PubMed  Google Scholar 

  25. Heidenreich A, Angerer-Shpilenya M. Organ-preserving surgery for testicular tumours. BJU Int. 2012;109(3):474–90.

    Article  PubMed  Google Scholar 

  26. Schmoll H-J, Jordan K, Huddart R, Laguna MP, et al. Testicular seminoma: ESMO clinical recommendations for diagnosis, treatment and follow up. Ann Oncol. 2009;20 Suppl 4:iv83–8.

    Google Scholar 

  27. Ethics Committee of the American Society for Reproductive Medicine. Ethics committee report: fertility preservation and reproduction in cancer patients. Fertil Steril. 2005;83(6):1622–8.

    Article  Google Scholar 

  28. Loren AW, Mangu PB, Nohr Beck L, et al. Fertility preservation for patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10.

    Article  PubMed  Google Scholar 

  29. Rorth M, Rajpert-De Meyts E, Andersson L, et al. Carcinoma in situ of the testis. Scand J Urol Nephrol. 2000;205 Suppl 6:166–86.

    Article  Google Scholar 

  30. von der Maase H, Rohrt M, Waldbom-Jorgensen S, et al. Carcinoma in situ of the contralateral testis in patients with testicular germ cell cancer: study of 27 cases in 500 patients. Br Med J (Clin Res Ed). 1986;293:1398–401.

    Article  Google Scholar 

  31. Dieckmann KP, Loy V. Prevalence of contralateral testicular intraepithelial neoplasia in patients with testicular germ cell neoplasms. J Clin Oncol. 1996;14:3126–32.

    CAS  PubMed  Google Scholar 

  32. van Casteren NJ, de Jong J, Stoop H, Steyerberg EW, et al. Evaluation of testicular biopsies for carcinoma in situ: immunohistochemistry is mandatory. Int J Androl. 2009;32:666–74.

    Article  PubMed  Google Scholar 

  33. Dieckmann KP, Kulejewski M, Pichlmeier U, Loy V. Diagnosis of contralateral testicular intraepithelial neoplasia (TIN) in patients with testicular germ cell cancer: systematic two-site biopsies are more sensitive than a single random biopsy. Eur Urol. 2007;51:175–83.

    Article  PubMed  Google Scholar 

  34. Fossa SD, Chen J, Schonfeld SJ, et al. Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men. J Natl Cancer Inst. 2005;97(14):1056–66.

    Article  PubMed  Google Scholar 

  35. Heidenreich A. Contralateral testicular biopsy in testis cancer: current concepts and controversies. BJU Int. 2009;104(9 Pt B):1346–50.

    Article  PubMed  Google Scholar 

  36. Chung P, Warde P. Stage I seminoma: adjuvant treatment is effective but is it necessary? J Natl Cancer Inst. 2011;103(3):194–6.

    Article  PubMed  Google Scholar 

  37. Schmoll HJ, Jordan K, Huddart R, Pes MP, et al. ESMO Guidelines Working Group. Testicular seminoma: ESMO clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol. 2010;21(5):40–6.

    Google Scholar 

  38. Warszawski N, Schmucking M. Relapses in early-stage testicular seminoma: radiation therapy versus retroperitoneal lymphadenectomy. Scan J Urol Nephrol. 1997;31(4):335–9.

    Article  Google Scholar 

  39. Mosharafa AA, Foster RS, Leibovitch BC, et al. Is postchemotherapy resection of seminomatous elements associated with higher acute morbidity? J Urol. 2003;169:2126–8.

    Article  PubMed  Google Scholar 

  40. Pont J, Höltl W, Kosak D, et al. Risk-adapted treatment choice in stage I nonseminomatous testicular germ cell cancer by regarding vascular invasion in the primary tumor: a prospective trial. J Clin Oncol. 1990;8:16–9.

    CAS  PubMed  Google Scholar 

  41. Read G, Stenning SP, Cullen MH, et al. Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol. 1992;10:1762–8.

    CAS  PubMed  Google Scholar 

  42. Heidenreich A, Sesterhenn IA, Mostofi FK, et al. Prognostic factors that identify patients with clinical stage I nonseminomatous germ cell tumors at low risk and high risk for metastasis. Cancer. 1998;83:1002–11.

    Article  CAS  PubMed  Google Scholar 

  43. Albers P, Siener R, Kliesch S, Weissbach L, et al. German Testicular Cancer Study Group. Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial. J Clin Oncol. 2003;21(8):1505–12.

    Article  PubMed  Google Scholar 

  44. Perrotti M, Ankem M, Bancilla A, et al. Prospective metastatic risk assignment in clinical stage I nonseminomatous germ cell testis cancer: a single institution pilot study. Urol Oncol. 2004;22(3):174–7.

    Article  PubMed  Google Scholar 

  45. Leibovitch I, Foster RS, Kopecky KK, et al. Identification of clinical stage A nonseminomatous testis cancer patients at extremely low risk for metastatic disease: a combined approach using quantitative immunohistochemical, histopathologic, and radiologic assessment. J Clin Oncol. 1998;16:261–8.

    CAS  PubMed  Google Scholar 

  46. Spermon JR, Roeleveld TA, van der Poel HG, et al. Comparison of surveillance and retroperitoneal lymph node dissection in stage I nonseminomatous germ cell tumors. Urology. 2002;59:923–9.

    Article  CAS  PubMed  Google Scholar 

  47. Oliver RT, Ong J, Shamash J, et al. Long-term follow-up of Anglian Germ Cell Cancer Group surveillance versus patients with Stage I nonseminoma treated with adjuvant chemotherapy. Urology. 2004;63:556–61.

    Article  CAS  PubMed  Google Scholar 

  48. Maroto P, Garcia del Muro X, Aparicio J, et al. Multicentre risk-adapted management for stage I non-seminomatous germ cell tumours. Ann Oncol. 2005;16:1915–20.

    Article  CAS  PubMed  Google Scholar 

  49. Tarin TV, Sonn G, Shinghal R. Estimating the risk of cancer associated with imaging related radiation during surveillance for stage I testicular cancer using computerized tomography. J Urol. 2009;181(2):627–32.

    Article  PubMed  Google Scholar 

  50. Atsü N, Eskiçorapçi S, Uner A, Ekici S, et al. A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours. BJU Int. 2003;92(1):32–5.

    Article  PubMed  Google Scholar 

  51. Rustin GJ, Mead GM, Stenning SP, et al. National Cancer Research Institute Testis Cancer Clinical Studies Group. Randomized trial of two or five computed tomography scans in the surveillance of patients with stage I nonseminomatous germ cell tumors of the testis: Medical Research Council Trial TE08, ISRCTN56475197 – the National Cancer Research Institute Testis Cancer Clinical Studies Group. J Clin Oncol. 2007;25(11):1310–5.

    Article  PubMed  Google Scholar 

  52. Kakiashvili DM, Zuniga A, Jewett MA. High risk NSGCT: case for surveillance. World J Urol. 2009;27(4):441–7.

    Article  PubMed  Google Scholar 

  53. Kollmannsberger C, Moore C, Chi KN, Murray N, et al. Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy. Ann Oncol. 2010;21(6):1296–301.

    Article  CAS  PubMed  Google Scholar 

  54. Divrik RT, Akdogan B, Özen H, Zorlu F. Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors – is shift to risk adapted policy justified? J Urol. 2006;176:1424–30.

    Article  PubMed  Google Scholar 

  55. Stephenson AJ, Bosl GJ, Motzer RJ, et al. Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer: impact of patient selection factors on outcome. J Clin Oncol. 2005;23:2781–8.

    Article  PubMed  Google Scholar 

  56. Al-Tourah AJ, Murray N, Coppin C, et al. Minimizing treatment without compromising cure with primary surveillance for clinical stage I embryonal predominant carcinoma nonseminomatous testicular cancer: a population based analysis from British Columbia. J Urol. 2005;174:2209–13.

    Article  PubMed  Google Scholar 

  57. Stephenson AJ, Bosl GJ, Bajorin DF, et al. Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion. J Urol. 2005;174:557–60.

    Article  PubMed  Google Scholar 

  58. Baniel J, Foster RS, Einhorn LH, et al. Late relapse of clinical stage I testicular cancer. J Urol. 1995;154:1370–2.

    Article  CAS  PubMed  Google Scholar 

  59. Yoon GH, Stein JP, Skinner DG. Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle: an update. Urol Oncol. 2005;23:168–77.

    Article  PubMed  Google Scholar 

  60. Jewett MA, Kong YS, Goldberg SD, et al. Retroperitoneal lymphadenectomy for testis tumor with nerve sparing for ejaculation. J Urol. 1988;139:1220–4.

    CAS  PubMed  Google Scholar 

  61. Donohue JP, Thornhill JA, Foster RS, et al. Primary retroperitoneal lymph node dissection in clinical stage A nonseminomatous germ cell testis cancer. Review of the Indiana University experience 1965–1989. Br J Urol. 1993;71:326–35.

    Article  CAS  PubMed  Google Scholar 

  62. Donohue JP, Foster RS, Rowland RG, et al. Nerve-sparing retroperitoneal lymphadenectomy with preservation of ejaculation. J Urol. 1990;144:287–91.

    CAS  PubMed  Google Scholar 

  63. Nicolai N, Miceli R, Necchi A, et al. Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours: long-term outcome and analysis of risk factors of recurrence. Eur Urol. 2010;58:912–8.

    Article  PubMed  Google Scholar 

  64. Rassweiler JJ, Scheitlin W, Heidenreich A, et al. Laparoscopic retroperitoneal lymph node dissection: does it still have a role in the management of clinical stage I nonseminomatous testis cancer? A European perspective. Eur Urol. 2008;54(5):1004–15.

    Article  PubMed  Google Scholar 

  65. Leibovitch I, Foster RS, Ulbright TM, Donohue JP. Adult primary pure teratoma of the testis. The Indiana experience. Cancer. 1995;75(9):2244–50.

    Article  CAS  PubMed  Google Scholar 

  66. Heidenreich A, Moul JW, McLeod DG, et al. The role of retroperitoneal lymphadenectomy in mature teratoma of the testis. J Urol. 1997;157(1):160–3.

    Article  CAS  PubMed  Google Scholar 

  67. Heidenreich A, Albers P, Hartmann M, et al. German Testicular Cancer Study Group. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol. 2003;169(5):1710–4.

    Article  PubMed  Google Scholar 

  68. Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicentric trial. J Clin Oncol. 2003;21(6):1101–6.

    Article  PubMed  Google Scholar 

  69. Logothetis CJ, Samuels ML, Selig DE, et al. Primary chemotherapy followed by a selective retroperitoneal lymphadenectomy in the management of clinical stage II testicular carcinoma: a preliminary report. J Urol. 1985;134:1127–30.

    CAS  PubMed  Google Scholar 

  70. Horwich A, Stenning S. Initial chemotherapy for stage II testicular nonseminoma. World J Urol. 1994;12:148–50.

    Article  CAS  PubMed  Google Scholar 

  71. Weissbach L, Bussar-Maatz R, Flechtner H, et al. RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumors? Results of a prospective multicenter trial including quality of life assessment. Eur Urol. 2000;37:582–94.

    Article  CAS  PubMed  Google Scholar 

  72. Sheinfeld J, Motzer RJ, Rabbani F, et al. Incidence and clinical outcome of patients with teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection for clinical stages I and II A nonseminomatous germ cell tumors. J Urol. 2003;170:1159–62.

    Article  PubMed  Google Scholar 

  73. Williams SD, Stablein DM, Einhorn LH, et al. Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Engl J Med. 1987;317:1433–8.

    Article  CAS  PubMed  Google Scholar 

  74. Pizzocaro G, Monfardini S. No adjuvant chemotherapy in selected patients with pathological stage II nonseminomatous germ cell tumors of the testis. J Urol. 1994;131:677–80.

    Google Scholar 

  75. Steiner H, Muller T, Gozzi C, et al. Two cycles of cisplatin-based chemotherapy for low-volume retroperitoneal stage II nonseminomatous germ cell tumours. BJU Int. 2006;98:349–52.

    Article  CAS  PubMed  Google Scholar 

  76. Weissbach L, Hartlapp JH. Adjuvant chemotherapy of metastatic stage II non-seminomatous testis tumor. J Urol. 1991;146:1285–98.

    Google Scholar 

  77. Kennedy BJ, Torkelson JL, Fraley EE. Adjuvant chemotherapy for stage II nonseminomatous germ cell cancer of the testis. Cancer. 1994;73:1485–9.

    Article  CAS  PubMed  Google Scholar 

  78. Kondagunta GV, Sheinfeld J, Mazumdar M, et al. Relapse-free and overall survival in patients with pathologic stage II nonseminomatous germ cell cancer treated with etoposide and cisplatin adjuvant chemotherapy. J Clin Oncol. 2004;22:464–7.

    Article  CAS  PubMed  Google Scholar 

  79. Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol. 2008;53(3):497–513.

    Article  PubMed  Google Scholar 

  80. Kollmannsberger C, Daneshmand S, So A, et al. Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery. J Clin Oncol. 2010;28(4):537–42.

    Article  PubMed  Google Scholar 

  81. Ehrlich Y, Brames MJ, Beck SD, et al. Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumors: is a postchemotherapy retroperitoneal lymph node dissection needed after complete remission? J Clin Oncol. 2010;28(4):531–6.

    Article  CAS  PubMed  Google Scholar 

  82. Pfister D, Busch J, Winter C, et al. Pathohistological findings in patients with nonseminomatous germ cell tumours who undergo postchemotherapy retroperitoneal lymph node dissection for small residual lesions. J Urol. 2011;185:e334.

    Article  Google Scholar 

  83. Heidenreich A. Residual tumor resection following inductive chemotherapy in advanced testicular cancer. Eur Urol. 2007;51:299–301.

    Article  PubMed  Google Scholar 

  84. Besse B, Grunenwald D, Fléchon A, et al. Nonseminomatous germ cell tumors: assessing the need for postchemotherapy contralateral pulmonary resection in patients with ipsilateral complete necrosis. J Thorac Cardiovasc Surg. 2009;137(2):448–52.

    Article  PubMed  Google Scholar 

  85. Jacobsen NE, Beck SD, Jacobson LE, et al. Is retroperitoneal histology predictive of liver histology at concurrent post-chemotherapy retroperitoneal lymph node dissection and hepatic resection? J Urol. 2010;184(3):949–53.

    Article  PubMed  Google Scholar 

  86. Winter C, Pfister D, Busch J, et al. Residual tumor size and IGCCCG risk classification predict additional vascular procedures in patients with germ cell tumors and residual tumor resection: a multicenter analysis of the German Testicular Cancer Study Group. Eur Urol. 2012;61(2):403–9.

    Article  PubMed  Google Scholar 

  87. Hendry WF, Norman AR, Dearnaley DP, et al. Metastatic nonseminomatous germ cell tumors of the testis: results of elective and salvage surgery for patients with residual retroperitoneal masses. Cancer. 2002;94:1668–76.

    Article  PubMed  Google Scholar 

  88. Beck SD, Foster RS, Bihrle R, et al. Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor ? Cancer. 2007;110:1235–40.

    Article  PubMed  Google Scholar 

  89. Heidenreich A, Pfister D, Witthuhn R, et al. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol. 2009;55(1):217–24.

    Article  PubMed  Google Scholar 

  90. Heidenreich A, Ohlmann C, Hegele A, Beyer J. Repeat retroperitoneal lymphadenectomy in advanced testicular cancer. Eur Urol. 2005;47(1):64–71.

    Article  PubMed  Google Scholar 

  91. McKiernan JM, Motzer RJ, Bajorin DF, et al. Reoperative retroperitoneal surgery for nonseminomatous germ cell tumor: clinical presentation, patterns of recurrence, and outcome. Urology. 2003;62(4):732–6.

    Article  PubMed  Google Scholar 

  92. Sexton WJ, Wood CG, Kim R, Pisters LL. Repeat retroperitoneal lymph node dissection for metastatic testis cancer. J Urol. 2003;169(4):1353–6.

    Article  PubMed  Google Scholar 

  93. Albers P, Ganz A, Hannig E, et al. Salvage surgery of chemorefractory germ cell tumors with elevated tumor markers. J Urol. 2000;164(2):381–4.

    Article  CAS  PubMed  Google Scholar 

  94. Beck SD, Foster RS, Bihrle R, Einhorn LH, Donohue JP. Outcome analysis for patients with elevated serum tumor markers at postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol. 2005;23(25):6149–56.

    Article  PubMed  Google Scholar 

  95. Logothetis CJ, Samuels ML, Trindade A, Johnson DE. The growing teratoma syndrome. Cancer. 1982;50:1629–35.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University Hospital Aachen, Aachen, Germany

    Axel Heidenreich MD, PhD

Authors
  1. Axel Heidenreich MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Axel Heidenreich MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Urology, Homerton University Hospital & Formerly St. Bartholomew's Hospital, London, United Kingdom

    Vinod H. Nargund

  2. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA

    Derek Raghavan

  3. Radiation Oncology, Cedars Sinai Cancer Center, Los Angeles, California, USA

    Howard M. Sandler

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Heidenreich, A. (2015). Testicular Cancer- Clinical Features, Staging and Surgical Management. In: Nargund, V., Raghavan, D., Sandler, H. (eds) Urological Oncology. Springer, London. https://doi.org/10.1007/978-0-85729-482-1_28

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-482-1_28

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-481-4

  • Online ISBN: 978-0-85729-482-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation