Carcinoma testis, the lymphatic metastasis goes to the first site seen in

(Para-aortic lymph node) (1386-Baily & Love 25th)Metastasis first develop in the retroperitoneal nodes; right sided tumours metastasize primarily to the inner aortocaval region just below the renal vessels and left sided tumours primarily to the left para-aortic area at the same level (953-CSDT 13th)Lymphatics of the Testis - runs upwards in the spermatic cord and passing through the internal inguinal rings.They branch fountain- wise (behind and adherent to the posterior peritoneum) towards the para-aortic lymphnodes in the region of the origin of spermatic vessels. Above this level the lymph drains into thoracic duct which extends through the mediastinum to the left supraclavicular fossa where it drains into the left innominate vein. Lymphatics from the medial side of the testis may run with the artery to the vas and drain into lymph node at the bifurcation of the common iliac arteryInguinal lymphnodes are only affected if the scrotum in involved.ALSO - REMEMBER* Most common tumour above 50 years of age - Lymphoma* Most common testicular tumour in prepubertal adults (Infant and children) is Yolk sac tumour* Seminoma are most common testicular tumours, better prognosis, most radiosensitive tumours* Non seminoma are more malignant than seminoma* Seminomas as well as nonseminomas typically metastasize through- lymphatics*** a- feto protein is elevated in 70% of patients with non seminomatous testicular cancer but is not elevated in seminoma* Markers {LDH, fihCG, a-fetoprotieri) are used mainly to follow tumour regression or predict recrudescence as even minute amounts of tumour may cause serum elevations however tumour may be present without elevation of serum markers* Most common germ cell tumour is - Seminoma