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Pojedyńczy węzeł chłonny okołoaortalny o wymiarze poprzecznym 12x7mm

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Lymphatic spread is the most common route of metastatic spread. The lymphatic drainage of the testis is directly to the para-aortic lymph nodes. There are differences in the distribution of metastases from left or right testicular tumors. The left testicular vein drains to the left renal vein, and the lymphatic drainage is primarily to the lymph nodes in the para-aortic area, directly below the left renal hilum. On the right side, the testicular vein drains directly to the inferior vena cava below the level of the renal vein, and, therefore, paracaval and interaortocaval nodes are the first ones to be involved in right-sided tumors.

Clinical stage II seminoma testicular cancer
Surgery to remove the testicle and lymph nodes with cancer is done first, followed by additional treatment, usually chemotherapy. The main factor in the treatment decision after surgery for a stage II seminoma is the size of the retroperitoneal lymph nodes. Men are also encouraged to consider sperm banking before the following treatments begin due to the risk of infertility.

Chemotherapy. Chemotherapy with a combination of drugs is given after surgery to remove the testicle if the lymph nodes are larger than 3 cm or if there are enlarged lymph nodes spread out over a large area in the back of the abdomen. This is a standard treatment option for all men with stage II seminoma and is preferred for stage IIB and stage IIC as it is more likely to get rid of the cancer.

Radiation therapy. When lymph nodes are less than 3 cm (stage IIA and early stage IIB), surgery may be followed by radiation therapy to the lymph nodes in the abdomen and pelvis. Alternatively, chemotherapy may be used instead of radiation therapy. Experts disagree about whether radiation therapy or chemotherapy is the preferred option for patients with stage IIA and early stage IIB. Both approaches cure 90% or more of patients with these stages.