Germ-Cell Testicular Cancer in Adults

(Second of Two Parts)TreatmentManagement of the Primary TumorAlthough it is well known that a tumorous testis should be removed through an inguinal incision with complete excision of the spermatic cord, many patients have a transscrotal biopsy or orchiectomy or incomplete excision of the cord. Any of these maneuvers may spill tumor into the scrotum, where it can gain access to the inguinal lymphatics or the subcutaneous lymphatics of the lower abdomen. These patients, as well as those whose tumors have penetrated the tunica albuginea or spread to the spermatic cord, should probably have a hemiscrotectomy. They may . . .