Carcinoma In Situ

The view in Denmark is that the contralateral testis should be explored at orchiectomy. The contralateral testis harbors carcinoma in situ (CIS) in approximately 5% of cases.57 This condition will lead to tes-ticular cancer in the years following orchiectomy, and it is conceivable that some "late relapses" are caused by this lesion.

It has not been the policy in the United States to perform a contralateral biopsy at the initial orchiec-tomy, probably because the development of a secondary testicular tumor is not a survival issue and because of a concern that 96% of patients would undergo unnecessary morbidity from a contralateral surgical procedure. That a secondary testicular tumor is not a survival issue may not always be true. Of patients with bilateral testicular germ cell tumors, 30 to 50% had disseminated tumor at the time of diagnosis of the second tumor, and 10 to 20% of the patients died of their secondary tumor.58-60 Although these data include data from patients from the precisplatin era, the development of a second testicular cancer is not

Figure 12-4. The number of computed tomography (CT) scans of the abdomen performed in patients with stage I nonseminomatous germ cell tumors at six centers (numbers from Groningen and Charing Cross include CT scans of the chest). (MSKCC = Memorial Sloan-Kettering Cancer Center.)

u-10 ■ 8 6. 4 ■ 2 0

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