Stage II is also divided into non-bulky and bulky. Bulky disease indicates extensive retroperitoneal lymph node involvement with more than five nodes generally greater than 3/4 in. (2 cm), one node more than 2 in. (5 cm), or tumor that has spread to the fat surrounding the lymph node.
In the AJCC staging system, Stage III means only N1, M0 with Stage IV being N2, M0 or N3, M0 or any T, any N, M1 (organ invasion).
Standard Treatment Radical inguinal orchiectomy followed by therapeutic doses of radiation therapy (at least 4,000 cGy) will cure more than 90 percent of non-bulky seminoma cases. Because of the potential need for chemotherapy at relapse and the questionable benefit of preventive radiation to the chest and neck, further radiation therapy is not recommended.
For bulky Stage II seminoma (greater than 4 in./10 cm), chemotherapy is preferred since older studies find the cure rate to be about 70 percent (admittedly, newer techniques and radiation equipment may produce better results).
Men with non-seminomatous germ cell Stage II cancer always used to have retroperitoneal lymph node dissection, but major controversies now exist as to the best form of therapy. For truly bulky masses (greater than 2 in. /5 cm), chemotherapy may be a much better approach, with surgery as the salvage treatment for any remaining masses.
