Radiotherapy for Tumors of the Testis

Abstract

FROM 1920 to 1936, inclusive, 314 patients with malignant tumors of the testis were treated at the Mayo Clinic (Table I). More than half (172) of these tumors were encountered in patients in the so-called cancer age, that is, between the ages of thirty and fifty years (Table II). The youngest patient in the series, however, was three years old, the oldest 83; in neither case, however, was the microscopic diagnosis made at the Clinic. The right testis was involved by the malignant tumor in 140 cases (45 per cent), the left in 165 cases (52 per cent). Both testes were said to be involved in four cases (1 per cent), but from the data available it was impossible to be sure whether both testes were actually involved simultaneously or, if not, which organ was to be regarded as the primary site of the lesion. The testis affected was not stated in the remaining five cases. In regard to the significance of undescended testis as a possible etiologic factor the data may lead to false impressions. This condition was mentioned 15 times in the records of cases in this series. Similarly, the data concerning the relationship of direct trauma to the development of malignant tumor of the testis, mentioned in 23 cases, may lead to misinterpretations. Most of these 314 patients came to the Clinic for consideration of their testicular lesion at least three months after they noticed something wrong with the organ; swelling of the testis was stated by 25 of the patients to have been present three years or more before the institution of treatment. A well-known fact, but one which is frequently lost sight of, is that metastasis to the para-aortic nodes occurs much earlier and more frequently than is generally recognized; it occurred 180 times in this series of cases. This metastasis is generally to nodes in the vicinity of the celiac axis and usually on the same side as the testicular tumor. The spread tends to remain localized in these nodes for a considerable time, and usually precedes metastasis to the supraclavicular nodes and lungs. Occasionally, however (in about 1 per cent of the cases), metastatic elements instead of passing through the thoracic duct may lodge in the mediastinal portion of it, and by growing there form a unilateral or bilateral secondary tumor which may extend outward into the lungs. Metastatic involvement of nodes outside the abdomen always is a secondary phenomenon, and takes place after localization of metastasis in the abdominal nodes has been present for a considerable time. Under ordinary conditions, metastasis takes place to the retroperitoneal nodes, to the “pilot” supraclavicular nodes, and to the lungs or other organs, in that order. Involvement of the inguinal nodes occurs only when the testicular tumor has perforated the capsule of the organ (in 10 to 15 per cent of cases). Metastasis to the lungs, usually regarded as a common event, is actually uncommon and was a relatively late complication in about 10 per cent of our cases.