A 28-year-old man presents to his urologist with a painless lump in his right testis. After a physical examination and ultrasound, the urologist suspects carcinoma of the testis and recommends further evaluation and treatment.
What is the appropriate surgical treatment for suspected carcinoma of the testis?
A. Trans-Scrotal percutaneous biopsy
B. Trans-scrotal open biopsy
C. Repeated examinations
D. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchiectomy if tumor is confirmed
Answer:
The Correct Answer is: D. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchiectomy if tumor is confirmed
Explanation:
Inguinal exploration, control of the spermatic cord, biopsy, and radical orchiectomy if tumor is confirmed (D):
– The standard and appropriate surgical treatment for a suspected testicular carcinoma involves inguinal exploration and radical inguinal orchiectomy. This approach allows for the control of the spermatic cord to prevent potential spread of cancer cells during the procedure.
– A trans-scrotal approach is avoided because it risks disrupting the lymphatic drainage patterns and potentially spreading the tumor, which could complicate further treatment and prognosis.
Explanation of Incorrect Options:
Trans-Scrotal percutaneous biopsy (A):
– A trans-scrotal percutaneous biopsy is not recommended because it can disrupt the testicular capsule and spread cancer cells into the scrotal sac and surrounding tissues, increasing the risk of local recurrence and complicating future management.
Trans-scrotal open biopsy (B):
– Similar to the percutaneous biopsy, a trans-scrotal open biopsy is not advised due to the risk of seeding cancer cells into the scrotum and altering the lymphatic drainage pathways. This could negatively impact the prognosis and complicate treatment.
Repeated examinations (C):
– While regular follow-up and examinations are important for monitoring testicular health, they are not a definitive treatment approach for suspected carcinoma. Delaying definitive treatment could allow the cancer to progress.
In conclusion, the appropriate surgical treatment for suspected carcinoma of the testis is inguinal exploration, control of the spermatic cord, biopsy, and radical orchiectomy if the tumor is confirmed, making option D the correct answer.