Treatment of testicular cancer

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Testicular cancer is usually treated with surgery. The testicle must be removed (orchiectomy) to remove the cancer (Fig. 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.

Fig. 1: Orchiectomy—incision in the groin area.
Fig. 1: Orchiectomy—incision in the groin area.

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 it is also necessary to take tissue from the other testicle, due to a possible precancerous lesion that may be present. This will depend on the type of cancer that is found in the one testicle.
  • Sometimes a false testicle (silicone implant) can be inserted for a more natural look and feel.

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.

Important: 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.

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?

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.

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.

What is a biopsy?

Ask your doctor about sexual side effects of RPLND

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.

Read more about chemotherapy

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.

Read more about radiation therapy

Testicular cancer treatment

Treatment

Stage 1 cancer

Stage 2 cancer

Stage 3 cancer
Surgery The testicle is removed (orchiectomy)
Additional surgery Biopsy of the other testicle may be done
  • If 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
Chemotherapy Possible if you have a high risk of the cancer coming back Yes Yes
Radiation therapy For seminoma only, if tissue exam shows the tumour starting to spread For seminoma only, may be used to kill cancer cells in the lymph nodes at the back of the abdomen

Managing common side effect

Infection

 Chemotherapy 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 quality

 Poor 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.

Tiredness

 Feeling tired during and after treatment is common and will usually pass after a few days. Staying active can help.

Upset stomache (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.

Diarrhoea

 Treatment can affect your bowel function. Manage diarrhoea with anti-diarrhoea medicine. A low-fibre diet can also help during treatment.

Skin changes

 Chemotherapy 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 moisturised and comfortable. Symptoms will usually go away after treatment is done.

Follow-up

Your doctor will schedule you for regular visits after treatment to see if the cancer has come back (recurrence). Visits may include a physical examination, blood tests, chest x-ray, and/or a CT scan to look for new tumours. Visits are usually more frequent just after treatment ends. Follow-up typically continues for at least 5 years. If there is no recurrence, you do not need further treatment.

Treatment of recurrence

If new cancer is detected during follow-up, it will be treated with surgery, chemotherapy, or radiation therapy, as described. Even with recurrence, the chance of cure is good.