Question

What is the treatment for a stage I testicular tumor?

• A. High orchidectomy
• B. High orchidectomy plus radiotherapy
• C. Scrotal orchidectomy
• D. Bilateral orchidectomy

Hint:

Seminoma spreads early to para-aortic nodes and responds well to radiation.

Answer 1

The Correct Option is B

Testicular tumours are staged and treated in a fixed sequence, and stage I means the disease is still confined to the testis.

1. High orchidectomy: removing the testis and cord through the groin is the correct first step for every case, but by itself it can miss microscopic spread to the retroperitoneal nodes in a stage I seminoma.
2. High orchidectomy plus radiotherapy: after the same groin removal, radiotherapy is given to the para-aortic lymph node area. Seminoma cells are very sensitive to radiation, so this step mops up any hidden microscopic disease and lowers the chance of relapse.
3. Scrotal orchidectomy: cutting through the scrotum instead of the groin can spread tumour cells into the scrotal skin and lymphatics, so it is avoided for testicular cancer.
4. Bilateral orchidectomy: removes the healthy testis along with the diseased one, which is not justified when only one side is involved.

Since the tumour is only in one testis with no visible spread, the standard plan is to remove it through the groin and then add radiotherapy to treat any microscopic nodal disease that imaging cannot pick up.

Let's summarize:

• The testis is always removed through the groin, never through the scrotum.
• Radiotherapy after orchidectomy treats hidden nodal spread in stage I seminoma.

The correct answer is high orchidectomy plus radiotherapy.