Editing Germ Cell Tumours (section)

==== Radical inguinal orchiectomy ====

* '''<span style="color:#ff0000">Testicular prosthesis should be discussed prior to orchiectomy.</span>'''
* '''<span style="color:#ff0000">Approach: inguinal</span>'''
** '''<span style="color:#ff0000">Trans-scrotal orchiectomy: contraindicated due to risks of scrotal violation (see above)</span>'''
*** '''Patients who have undergone scrotal orchiectomy for malignant neoplasm should be counseled regarding the increased risk of local recurrence and may rarely be considered for adjunctive therapy (excision of scrotal scar or radiotherapy) for local control'''
**** In patients that have received systemic therapy following scrotal orchiectomy, local relapse is rare and adjuvant therapy is not needed
* '''<span style="color:#ff0000">Patients suspected of having a testicular neoplasm should undergo a radical inguinal orchiectomy with removal of the tumor-bearing testicle and spermatic cord to the level of the internal inguinal ring.</span>'''
** '''In very rare cases where there is a possibility of a benign tumour, excisional biopsy with a frozen section should be performed prior to definitive orchiectomy to allow for the possibility of organ-sparing partial orchiectomy.'''

* '''<span style="color:#ff0000">Timing</span>'''
** '''<span style="color:#ff0000">In general, orchiectomy should be performed prior to any further treatment.</span>'''
*** '''<span style="color:#ff0000">Exception: in patients with life-threatening metastatic disease and an unequivocally elevated AFP and/or HCG, orchiectomy should not delay the start of chemotherapy and can be postponed until later in the treatment course</span>'''