Different types of treatments are available for patients with testicular cancer. Some treatments are standard (the most commonly used treatment across all oncologists), and some are being tested in clinical trials. The oncologist’s recommendation for one patient may be different for another based on factors such as type and stage.
Most men will start with surgery to remove the testicle. After determining whether the cancer has spread and the type of testicular cancer it is, one or more treatments such as surveillance, chemotherapy, radiation therapy, and high-dose chemotherapy with stem cell transplant, may be recommended by the urologist or oncologist.
Surgery to Remove the Testicle
After the doctor removes the testicle (called orchiectomy), the tumor will be evaluated to determine what types of testicular cancer it is and to see if it has spread. Some men will have the lymph nodes removed in the groin area during the initial surgery or in a follow-up surgery to help determine whether it’s spread beyond the testicle.
Testicular surgery can result in short-term or long-term side effects depending on whether one or both testicles was removed. These could include:
- Pain or tenderness around the incision site
- Bleeding, reaction to anesthesia, infections, and blood clots
- Loss of sex drive and inability to get or maintain an erection
- Depression or other mood changes
- Loss of muscle mass and fatigue
Surveillance (watchful waiting) is closely following your condition without giving any treatment unless there are changes in test results. Some considerations for choosing surveillance instead of an aggressive treatment plan might include the fact that your testicular cancer is slow growing and in an early stage of development. Your oncologist could also recommend surveillance if he or she feels your age or other health concerns might undermine the effectiveness of treatment.
If your testicular cancer has not spread beyond the testicles, it is possible for your oncologist to closely monitor your status for up to 10 years. Regular three to six-month checks, that include image testing, by your doctor should follow your initial decision for surveillance. Only if these tests confirm that cancer has not spread beyond the testicles, no further treatment is needed.
Chemotherapy is most often used for patients whose cancer has spread outside the testicle. It's also used to help decrease the risk of cancer coming back after the testicle is removed. It's not typically used to treat cancer that's only in the testicle. When chemotherapy is used, it is given directly into a vein so that it enters the bloodstream and reaches cancer cells throughout the body.
External radiation therapy is typically used to treat testicular cancer that has spread to lymph nodes or to distant organs like the brain. External radiation is most common, using a beam of radiation focused typically at the back of the abdomen (the retroperitoneal lymph nodes). Radiation therapy is able to kill any tiny bits of cancer in those lymph nodes that can’t be seen. It can also be used to treat small amounts of seminoma that have spread to the nodes (based on changes seen on images that are taken such as CT Scans or PET Scans).
High-dose Chemotherapy With Stem Cell Transplant
Testicular cancer can often be treated successfully with chemo, but sometimes a stronger dose is needed, especially if the cancer has returned. Doctors can use stem cell transplant to counter higher doses of chemo. According to cancer.gov, high doses of chemotherapy are given, killing both cancer cells and healthy cells, including blood-forming cells. A stem cell transplant is then given after the cells are destroyed to replenish the blood-forming cells. A stem cell transplant takes stem cells (immature blood cells) from the blood or bone marrow of the patient (before treatment began) or a donor during the weeks leading up to the surgery. The cells are frozen and stored, and used as the patient needs.
The stored stem cells are thawed and given back to the patient through an infusion. Once the cells return to the bone marrow, they can begin to make new blood cells.
Stem cell transplants are usually used to treat recurring testicular cancer. The patient might need to stay in the hospital for a period of time during this treatment.