Stage I nonseminomatous testicular cancer is typically treated with radical orchiectomy plus what adjunct procedure?

• A. Chemotherapy
• B. Radiation therapy
• C. Radical orchiectomy with retroperitoneal lymph node dissection
• D. Cystectomy

Answer: (C)

In stage I nonseminomatous germ cell tumors, spread tends to go to the retroperitoneal lymph nodes. After removing the affected testicle, surgically removing the retroperitoneal lymph nodes addresses any micrometastatic disease and provides accurate staging. This nodal dissection can be curative in many patients and often spares them from immediate systemic chemotherapy. Nonseminomatous tumors are not particularly radiosensitive, so radiation therapy isn’t the preferred adjunct, unlike seminomas where radiation plays a bigger role. Cystectomy isn’t relevant to this cancer, since the disease originates in the testis and the nodal basin, not the bladder.