A 28-year-old white male presents with asymptomatic testicular enlargement. After a thorough physical examination and imaging, the physician suspects a testicular tumor.
Which of the following statements is/are true concerning his diagnosis and management?
A. Tumor markers, alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) will both be of value in the patient regardless of his ultimate tissue type
B. Orchiectomy should be performed via scrotal approach; the diagnosis of seminoma should be followed by postoperative radiation therapy
C. With current adjuvant chemotherapy regimens, retroperitoneal lymphadenectomy is no longer indicated for nonseminomatous testicular tumors
Answer:
The Correct Answer is: A. Tumor markers, alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) will both be of value in the patient regardless of his ultimate tissue type
Explanation:
A. Tumor markers, alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) will both be of value in the patient regardless of his ultimate tissue type:
– AFP and HCG are important tumor markers in the diagnosis and management of testicular cancer. Elevated levels of these markers can help in diagnosing the type of testicular cancer, monitoring response to treatment, and detecting recurrence.
– AFP is typically elevated in nonseminomatous germ cell tumors (NSGCT), while HCG can be elevated in both seminomas and nonseminomas.
Explanation of Incorrect Options:
B. Orchiectomy should be performed via scrotal approach; the diagnosis of seminoma should be followed by postoperative radiation therapy:
– Orchiectomy should be performed via an inguinal approach, not a scrotal approach, to prevent disruption of the lymphatic drainage and reduce the risk of spreading cancer cells.
– Seminomas are indeed sensitive to radiation, and postoperative radiation therapy is often used for seminomas, but the surgical approach via scrotum is incorrect.
C. With current adjuvant chemotherapy regimens, retroperitoneal lymphadenectomy is no longer indicated for nonseminomatous testicular tumors:
– Retroperitoneal lymph node dissection (RPLND) is still an important part of the management for certain cases of nonseminomatous germ cell tumors, especially for staging and in cases where there is residual mass after chemotherapy.
– While chemotherapy has significantly improved outcomes, RPLND remains indicated in specific scenarios, particularly for high-risk patients or those with residual disease.
In conclusion, the statement that is true concerning the diagnosis and management of a 28-year-old male with asymptomatic testicular enlargement is that tumor markers AFP and HCG will both be of value in the patient regardless of his ultimate tissue type, making option A the correct answer.