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Testicular cancer treatments

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 20, 2021.

Testicular cancer is most often treated with surgery. Radiation therapy and chemotherapy may also be an option to kill cancer cells after surgery or if the cancer has spread to other parts of the body. Your multidisciplinary team of cancer experts will answer your questions and recommend treatment options for your testicular cancer based on your unique diagnosis and needs. This guide covers the common treatments for testicular cancer.

Surgery

Two primary types of surgery are used to treat testicular cancer.

Radical inguinal orchiectomy: With a radical inguinal orchiectomy, your surgeon will remove the testicle with the tumor, as well as the spermatic cord that connects the testicle to the abdomen.

This treatment option is used for early-stage and advanced-stage seminoma and non-seminoma. Short-term risks after the procedure include discomfort and bleeding in the scrotum (known as hematoma). After surgery, you may need to take a testosterone replacement.

Retroperitoneal lymph node dissection: If your doctor suspects that the cancer cells may have spread to nearby lymph nodes, this procedure may be performed at the same time, or during a second surgery.

During this type of surgery for testicular cancer, an incision is made in the abdomen, and lymph nodes behind the abdomen are removed and examined by a pathologist for evidence of tumor cells. In some cases, the surgeon may be able to perform this operation by making a much smaller incision and using a narrow, lighted tube (a laparoscope) to see inside the abdomen, and long surgical instruments to remove the lymph nodes. Patients generally recover faster and have fewer complications after laparoscopic surgery than after a standard open procedure.

After surgery, there’s a chance of infection and blockages to the bowel. If you have open surgery, rather than laparoscopic, you may have a larger scar and will need to allow time to heal.

Laparoscopic surgery

During laparoscopic surgery, a laparoscope is used to remove lymph nodes from your abdomen. Laparoscopic surgery is usually done on patients with early-stage non-seminomas to determine whether cancer is present in the lymph nodes. The surgeon will make a number of small incisions and the surgical tools are inserted through the incisions to perform the procedure and remove the lymph nodes.

Patients often recover faster and experience fewer side effects after this procedure, compared with open surgery. However, there may be a risk of not removing all of the cancer cells with this type of procedure. That’s why if cancer is found in the lymph nodes, your care team may recommend chemotherapy after the surgery. As with open surgery, there’s also a chance of infection, bleeding and discomfort.

Partial orchiectomy

A partial orchiectomy is similar to a radical inguinal orchiectomy. However, with this procedure, some of the testicle is spared.

It’s more often used if:

  • There’s localized testicular cancer
  • You have one testicle
  • You have other health issues, such as an inability to produce androgen

You may feel some discomfort after surgery, and there’s also a risk of infection and bleeding.

Chemotherapy

Your oncologists may use chemotherapy after surgery to destroy remaining testicular cancer cells. Chemotherapy may also be used to treat testicular cancer that has spread to other organs, or that has come back after surgery.

In some cases, when the cancer has returned after chemotherapy or become resistant to the therapy, a more intensive chemotherapy regimen in combination with a stem cell transplant may be recommended. In this procedure, doctors collect normal blood-forming stem cells from your bloodstream over the course of several days. These stem cells are saved and frozen. Then, after the high-dose chemotherapy is administered, you receive an infusion of your own stem cells, which settle in your bone marrow and begin making new blood cells again.

Chemotherapy tends to be used on patients with advanced-stage cancer. It’s an appropriate treatment for testicular cancer but can be hard on the immune system, so your general health may factor into the decision to go with chemotherapy.

During chemotherapy, you may feel tired or nauseous. Other side effects include:

Some chemotherapy treatments may also lead to long-term side effects, such as:

  • Hearing loss
  • Kidney damage
  • Heart problems

Before starting chemotherapy, your care team can discuss all the benefits and risks that are specific to your chemotherapy drug.

Radiation therapy

Using a variety of radiation therapy delivery systems, our doctors are better able to target difficult-to-reach lymph nodes in the abdomen or pelvis that may contain testicular cancer tumor cells. Our radiation oncologists also use this technology to direct higher radiation doses at testicular cancer cells, while reducing exposure to normal, healthy tissue, such as to the bowel or kidneys. When radiation therapy is used to treat testicular cancer, special precautions are taken to shield the remaining testicle and preserve fertility. Types of radiation therapy that may be used for testicular cancer include:

External beam radiation therapy (EBRT) is the standard-of-care treatment for delivering radiation to lymph nodes in the abdomen or pelvis that may be hiding testicular cancer cells.

Intensity modulated radiation therapy (IMRT) allows doctors to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy tissue from harmful doses of radiation.

TomoTherapy® uses built-in computed tomography (CT) scanning to confirm the exact shape and location of a tumor before treatment begins.

Radiation therapy is used for patients with seminoma, as this cancer type responds well to this treatment. It’s sometimes used after surgery to ensure no cancer cells were left behind, and it can also be used for cancers that have spread to other parts of the body such as the brain.

After radiation, you may experience diarrhea, fatigue and nausea. These side effects typically go away with time after treatment ends.

Testicular cancer surveillance

After an orchiectomy, you’ll likely be finished with active treatment but may still visit your doctor regularly for surveillance. Using CT scans and blood tests, doctors can make sure that no cancer remains after surgery. Surveillance also looks for recurrent cancer, which means cancer that has returned after treatment has finished.

Surveillance may go on for five to 10 years after the initial treatment is complete.

Testicular prosthesis

After surgery for testicular cancer, some patients feel self-conscious due to the changes to their bodies. You may opt to have a testicular prosthesis inserted, which is an implant that mimics the appearance of a testicle.

A prosthesis doesn't function as a normal testicle would, so you may require testosterone therapy after surgery.

Fertility preservation

Testicular cancer treatments may affect your hormone levels and testicles, sometimes making it difficult to produce enough sperm to father children. If you think you may want to have children, it’s important to speak with your care team about this before beginning treatment, so they may provide guidance on how to best preserve your fertility.

If you’ve already gone through puberty, you may choose to store sperm in a sperm bank before treatment for future use. There are several methods that may be used to collect sperm in addition to ejaculation. Researchers are also looking at other ways to preserve fertility in younger boys who need to undergo treatment but aren’t producing sperm yet.

Clinical trials

You may be eligible to participate in a clinical trial. These allow you to access brand-new treatments that are not yet available to the public. As a participant, you’ll receive a high standard of care, and you’ll help doctors develop new treatment options for future patients.

Your care team can provide more information on current clinical trials.

Questions to ask your doctor when deciding on a treatment plan

For some, it may be difficult to work out which treatment option is appropriate. Asking the following questions may help you make an informed decision about your health care:

  • Which treatment option do you recommend?
  • What are the side effects of each treatment?
  • Which treatments may preserve my fertility?
  • What should my recovery process look like?
  • How soon can I return to work?
  • What will my out-of-pocket costs be for each treatment option?

Next topic: What are the facts about testicular cancer?

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