A 28-year-old white male presents with asymptomatic testicular enlargement. Which of the following statement(s) is/are true concerning his diagnosis and management?

c. The diagnosis of seminoma should be followed by postoperative radiation therapy

Testis cancer is most common between the ages of 25 and 34 and is rare in blacks. The most common malignant neoplasm of the testis arise from the germ cells and can represent a variety of histologic manifestations, e.g, choriocarcinoma, embryonal cell carcinoma, seminoma, and teratoma. For therapeutic purposes, the tumors can be divided into seminomas and nonseminomas. The usual presenting symptom is testicular enlargement that may be associated with mild discomfort. Any solid testicular mass should be considered suspicious for testis carcinoma. The diagnostic and therapeutic approach for any suspected testis carcinoma is inguinal exploration with orchiectomy if the operative findings confirm the presence of a testicular mass. The inguinal approach is employed to perform high ligation of the cord at the inguinal ring and to eliminate potential involvement of the inguinal lymph nodes which are the primary area of drainage for the scrotum. The tumor markers, a-fetoprotein (AFP) and the b-human chorionic gonadotropin (HCG) can contribute to both diagnosis and followup of testis cancer. Tumor markers are helpful when obtained prior to and following orchiectomy to help in assessing the stage of the tumor. Pure seminoma does not cause elevated AFP but can produce a moderate rise in HCG in 10% of patients. Seminomas are very responsive to radiation. Patients with minimal to moderate tumor burden (Stage I or II) are usually treated with radiotherapy. The field of treatment encompasses the para-aortic and para-caval areas below the diaphragm and ipsilateral inguinal and pelvic areas. When bulky retroperitoneal and/or distant metastases are present, cisplatin-based combination chemotherapy is the preferred treatment. The treatment of non-seminomatous tumors is more controversial. Stage I tumors are effectively treated with retroperitoneal lymphadenectomy. If bulky stage II and stage III non-seminomatous tumors are present, initial treatment includes cisplatin-based chemotherapy. Evidence for residual disease with normalization of tumor markers is usually an indication for surgical exploration.