Mary K Gospodarowicz Md Frcpc Frcr Hon Padraig Rwarde Mb Mrcpi Frcpc

The majority (more than 75%) of patients with seminoma present with clinical stage I disease; that is, no apparent involvement is found outside the testis.1,2 The classic presentation of stage I disease is painless testicular enlargement although up to 30% of patients can have some pain at presentation. The traditional management of patients with stage I semi-noma involves inguinal orchiectomy, which provides detailed information on tumor pathology, information on the extent of primary disease, and local tumor control. Local recurrence in the scrotum following surgery is exceedingly uncommon, at least in the case of surgery performed (and presentation with small- to moderate-sized tumors) in the developed world. The current management options for patients with stage I seminoma include (1) adjuvant postoperative external beam radiotherapy directed to para-aortic lymph nodes alone or to para-aortic and pelvic lymph nodes, (2) surveillance, and (3) adjuvant chemotherapy. The usual approach to management involves adjuvant external beam radiotherapy to the regional lymph nodes; to date, this remains the treatment of choice in most centers. The prognosis of stage I seminoma is excellent, with an overall disease-specific survival rate approximating 100%. The choice of treatment depends on local expertise and patient preference.

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