- evidence of chemo - alopecia
- scars
- scrotal lump
- no cough impulse
palpate:
- +/- tender
- hard, irregular surface
- upper border felt (can get above)
- cannot feel testicle
- +/- secondary hydrocele
- tumour not fluctuant, not tranilluminant
- groin lymph nodes (drain skin only, scrotum drain to para-aortic nodes)
- look for metastasis
- generalised lymphadenopathy
- abd and chest exam
- scrotal USG
- blood x tumour markers
- access extent of tumour (CXR, CT Abd, PET)
- NO aspirate/biopsy (fear seeding)
Mx:
- Orchidectomy - radical (early clamping of cord to prevent spread, avoid scrotal skin incision to prevent seeding)
- +RT/chemo
Seminoma = RT/chemo sensitive
Non seminomatous germ cell tumour = less RT/ chemo sensitive
