When would a biopsy be recommended?
If there is a suspicious mass in the testicle or if the ultrasound shows a mass within the testicle, then the proper approach is to explore this through an incision in the groin. A biopsy through the scrotum is generally contraindicated because of the risk of spilling some tumor cells into the scrotum and lymph nodes.
What are the different kinds of testicular cancer?
Once the testicle has been removed, the pathologist can study the entire testis and come up with the type of tumor. About half of these patients have pure seminoma, which is a tumor that is very sensitive to either chemotherapy or radiation. The other half of the tumors are called non-seminomatous tumors. They tend to be mixed subtypes, which could include embryonal cancer or choriocarcinoma or yolk sac elements. There are different elements that can occur in the testis and each of these have their own prognosis because the nonseminomas don't respond well to radiation.
What factors do you consider when you're deciding what treatment is appropriate?
When you're considering treatment, you want to know whether it's a pure seminoma, and if it's non-seminomatous tumor, you want to know the percentage of the subtypes as well. You'll also consider the stage of the cancer, how much of the testicle is involved, as well as the presence or absence of cancer cells in the lymph nodes and blood vessels and whether it has spread to nearby areas.
