Testicular Cancer

Treatment

How is testicular cancer treated?

How is testicular cancer treated?

Testicular cancer is usually treated with surgery. The testicle must be removed (orchiectomy) to remove the cancer (Figure 1). The tissue may be examined during surgery to confirm the diagnosis and stage. Additional surgery, drug treatment (chemotherapy), or radiation therapy also may be needed.

Testicular Cancer Treatment

TreatmentStage 1 cancerStage 2 cancerStage 3 cancer
SurgeryThe testicle is removed (orchiectomy)
Additional surgeryBiopsy of the other testicle may be doneIf non-seminoma, some lymph nodes may be removed

Biopsy of the other testicle may be done

If non-seminoma, some lymph nodes may be removed

Tumours that have spread to other areas will be removed, typically after chemotherapy

Biopsy of the other testicle may be done

ChemotherapyPossible if you have a high risk of the cancer coming backYesYes
Radiation therapyFor seminoma only, if tissue exam shows the tumour starting to spreadFor seminoma only, may be used to kill cancer cells in the lymph nodes at the back of the abdomen

Surgery to remove the testicle

All testicular cancers are treated with surgery, with very few exceptions.

  • An incision is made in the groin so the doctor can look at the testicle.
  • Tissue may be taken to confirm the diagnosis and stage.
  • If cancer is found, the whole testicle will be removed.
  • Sometimes a false testicle (silicone implant) can be inserted for a more natural look and feel.

 

Fig. 4: orchiectomy - incision in the groin.
Fig. 1: orchiectomy – incision in the groin.

There are usually few complications with removal of the testicle. You might have bleeding or an infection after surgery. In the long term, you might have poor semen quality or low testosterone. This can affect your ability to father children.

Tell your doctor before orchiectomy if you wish to have children after treatment. Most men can become fathers even after treatment for testicular cancer. However, you should be offered semen analysis and cryopreservation of sperm (freezing deposits of sperm samples in a sperm bank) as options.

Additional surgery

Other surgery might include biopsy of the other testicle, removal of lymph nodes, or removal of testicular cancer tissue from the lungs, liver, or other sites.

Biopsy of the other testicle

Your doctor may recommend taking tissue from the other testicle to look for precancerous cells. This should be considered especially if you had an undescended testicle, if you have very small testicles, or if you have poor semen quality. Precancerous cells are treated with radiation or removal of the testicle.

Removal of lymph nodes

If testicular cancer cells spread, they often go to the lymph nodes at the back of the abdomen. Removal of these lymph nodes is called “retroperitoneal lymph node dissection” (RPLND). This surgery is considered for men with a high risk of cancer spreading. It might also be performed to remove any cancer that remains after chemotherapy.

  Ask your doctor about sexual side effects of RPLND

Your sex life can be affected by surgery to remove the lymph nodes at the back of your abdomen:

  • RPLND can cause your semen and sperm to go backward into your bladder instead of coming out of your penis (retrograde ejaculation). Your orgasms will feel different because they will be dry. Medication helps sometimes, but you might not be able to have children by natural sexual intercourse.
  • RPLND can cause nerve damage that can affect the ability to have erections.
    Before you have your lymph nodes removed, talk to your surgeon about other possible side effects.

Removal of tumours at other sites

The spread of testicular cancer cells might have caused tumours to grow in other tissues and organs. These tumours are typically treated with chemotherapy. Surgery might be performed after chemotherapy to remove any cancer that remains.

Questions to ask your doctor about surgery:

  • Why do I need surgery?
  • Will the surgery affect my sex life?
  • Will I be able to have children after this surgery?
  • How long will I be in hospital?
  • How long will I have to be off work or on sick leave?
  • Will I be in pain?
  • Can I have a false testicle put in?
  • What are the possible complications?

Chemotherapy

Chemotherapy treats cancer with drugs that kill cancer cells. Chemotherapy drugs are usually given through an IV directly into the bloodstream. Chemotherapy is usually given one to four times at 3-week intervals, depending on the stage of the disease.

Your doctor may recommend the drug carboplatin or a combination of bleomycin, etoposide, and cisplatin (called “B-E-P”). These drugs treat high-risk testicular cancer or cancer that has spread. They are very effective but may have some side effects. Side effects are usually mild and go away once treatment ends.

Common side effects of chemotherapy:

  • Infection—contact your doctor if you have a fever, chills, or cough
  • Hair loss—will usually grow back in 3-6 months
  • Tiredness
  • Upset stomach (nausea)
  • Mouth sores
  • Sensory changes in taste or hearing
  • Changes in skin or nails
  • Tingling in fingers or toes

Questions to ask your doctor about chemotherapy:

  • Do I need chemotherapy?
  • Can I do anything to prevent side effects?
  • What should I do if I get an infection?
  • How long will I have chemotherapy for?
  • How long will I need to be off work or school?
  • How will I know if chemotherapy is working?

Radiation therapy

Radiation therapy treats cancer by exposing cancer cells to high energy rays. The rays damage and kill the cells. Radiation therapy is sometimes used to treat seminoma-type testicular cancer, but not non-seminoma tumours. The goal of radiation therapy is usually to kill cancer cells that have spread to the lymph nodes behind the abdomen.
Radiation can also damage healthy cells in other organs, so the radiation beam must target the cancer cells to limit damage. Side effects are usually mild.

Common side effects of radiation therapy:

  • Impaired semen quality
  • Stomach or GI symptoms, including peptic ulcer
  • A small risk that the radiation will cause another type of cancer
  • Tiredness
  • Sore skin
  • Upset stomach (nausea)
  • Diarrhoea
  • Temporary sperm damage

Questions to ask your doctor about radiotherapy:

  • Why do I need radiotherapy?
  • Are there any other treatment options?
  • How can I prevent side effects?
  • Are there any permanent side effects from this treatment?
  • How long will the course of treatment take?
  • Will I need to be off work or school?

Managing Common Side Effects

Side effectStrategy
InfectionChemotherapy reduces your white blood cell count, which increases your risk of infection. Contact your doctor if you have a fever, chills, or cough. If you have an infection, you might need antibiotics to treat it.
Poor semen qualityPoor semen quality after testicular cancer treatment can make it difficult for some men to father children. Before treatment begins, tell your doctor if you wish to have children. You might want to have semen analysis and preserve sperm samples in a sperm bank for later use.
TirednessFeeling tired during and after treatment is common and will usually pass after a few days. Staying active can help.
Upset stomach (nausea)Chemotherapy and radiation therapy can upset your stomach or make you lose your appetite. Tell your doctor or nurse if this happens.

  • Anti-nausea medicine can help calm your stomach. 
  • If you do not feel like eating, a high-calorie food supplement drink can provide nutrition.
  • Consult the hospital dietician if you have ongoing problems with your diet.
DiarrhoeaTreatment can affect your bowel function. Manage diarrhoea with anti-diarrhoea medicine. A low-fibre diet can also help during treatment.
Skin changesChemotherapy can cause changes in your skin and nails. Radiation therapy can cause the treated area to become red and sore like a sunburn. Talk with your doctor about how to keep your skin moisturized and comfortable. Symptoms will usually go away after treatment is done.
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