What is the initial definitive treatment for most testicular cancers?

• A. Chemotherapy
• B. Radiation therapy
• C. Radical inguinal orchiectomy
• D. Observation

Answer: (C)

The key idea is that removing the tumor through an inguinal approach is both diagnostic and curative for the primary lesion. Most testicular cancers are germ cell tumors, and the best first step is radical inguinal orchiectomy because it completely removes the primary tumor and provides tissue for definitive histology and staging. Approaching the testicle via the inguinal route (high ligation of the spermatic cord) avoids spreading cancer cells to the scrotum and preserves the natural lymphatic drainage patterns, which helps with accurate staging. Once the testicle is removed and the pathology is known, further treatment—such as surveillance, chemotherapy, or radiotherapy—is tailored to the stage and histology. Chemotherapy or radiation may be used later, but they are not the initial definitive treatment for most cases.