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Testicular Cancer Surgery

Learn about testicular cancer surgery in this Howcast video.


So when we discuss surgery for testicular cancer what we're talking about usually the initial surgery that is done is a procedure that is done is called a radical inguinal orchiectomy. What that means orchiectomy refers to the removal of the testicle.

The word radical implies that you're doing it for the purpose of diagnosing a cancer. Inguinal means that you're doing it through an incision in the groin rather than making an incision in the scrotum. When there's a suspicious that there can be a cancer in the testicle we make an incision higher in the groin area similar to an incision that would be made for a hernia operation. What we then do through that incision we then have access to a structure called the spermatic cord. The spermatic cord goes down the testicle and it carries the blood vessels and the vas which is the tube that carries sperm from the testicle. We then encircle that cord and one of the goals of the surgery is to perform high ligation of the spermatic cord.

We dissect the cord up high and we tie it off, and divide the cord at that level. Then we bring the testicle out through that incision remove both the spermatic cord, and the testicle itself. This procedure again is called a radical inguinal orchiectomy and it allow us to remove the affected testicle so that it can be sent for evaluation by the pathologist. They then will tell us the type of cancer that is involved as well as the extent of cancer.

Once a diagnosis has been made then we go on to doing various diagnostic procedures to determine the extent of the cancer. Now throughout the course of the treatment for testicular cancer patients may undergo chemotherapy, they may undergo radiation, they may not undergo any additional treatments and may just undergo surveillance which requires a series of imaging processes to make sure that there's no recurrence of cancer

In some cases where patients have extensive disease that's located up here in the abdominal area then as urologists we will sometimes perform a procedure called a retro peritoneal lymph node dissection. This is a major operation where we enter the abdominal cavity and we remove all the lymph nodes that exist around the aorta, and vena cava. The aorta is the largest artery in your body, and the vena cava is the largest vein in your body. There's a series of lymph nodes that exist in fatty tissue around those structures that can be affected by spread of testicular cancer.

When we perform that operation we are removing all the lymph nodes in that area to see where there is cancer that has spread to those sites. Surgeries for testicular cancer can vary, but almost always there is a orchiectomy involved, and in some cases we may do this more extensive surgeries that I have talked about to remove lymph nodes from the abdominal area.

Depending on where else cancer has spread there may be a role for various other procedures that might be necessary. For example, if there's cancer that exists in the chest and it needs to be removed sometimes we employ the assistance of thoracic surgeons to help us remove those lymph nodes as well. Depending on the extent of cancer that determines the nature of surgeries you may or may not need. Almost everybody with testicular cancer will initially undergo a radical orchiectomy.

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