Seminomas and teratomas may spread locally, through the bloodstream or through the lymphatics.
Local spread - the testis is progressively destroyed. Unusually, the tumour spreads through the capsule and in advanced cases, may ulcerate the scrotum.
Blood-borne - teratomas spread relatively early to the lungs and liver. Seminomas spread similarly, but much later.
Lymphatics - commonly to the para-aortic nodes at the level of the umbilicus. In advanced cases, the tumour may reach the supraclavicular nodes, especially on the left side. Inguinal lymph nodes may become involved if ulceration of the scrotum occurs.
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