Testicular Cancer – Treatment Overview

If you are diagnosed with testicular cancer, your doctor will explain what type of cancer you have, whether it has spread beyond the testicle (metastasized), and the potential for curing it. You and your doctor will discuss your treatment options and possible outcomes of those treatments. Testicular cancer is considered a highly curable disease, especially when diagnosed at an early stage.3
Initial treatment

Treatment for testicular cancer begins with a radical inguinal orchiectomy, which is surgery to remove the affected testicle(s). Depending on which type of cancer cells are present and whether your cancer has spread to other areas of your body (stage), this procedure may be followed by one or more of the following treatments:

* Watchful waiting. This is a period of time during which you are being monitored by your doctor but are not receiving treatment. It is also called observation or surveillance.
* Radiation therapy. Radiation therapy is the use of high-dose X-rays to destroy cancer cells and shrink tumors. This type of treatment is commonly used to treat seminomas, as these cells are highly sensitive to radiation. Radiation therapy is not effective in treating nonseminoma cancers.
* Chemotherapy. Chemotherapy is the use of very powerful medicines to destroy cancer cells. The most common chemotherapy used to treat testicular cancer is called cisplatin combination therapy and involves the use of several different medicines. This treatment varies in intensity and is often used for men whose cancer has spread beyond the testes to lymph nodes or other organs.
* Additional surgery, which may be required to remove cancer cells that have spread to lymph nodes or other areas of your body. One type of surgery, called a retroperitoneal lymph node dissection (RPLND), is a common treatment for nonseminomas involving the removal of lymph nodes in the abdomen and lower back.

Some stage I testicular cancers are successfully treated with watchful waiting programs rather than chemotherapy or radiation therapy. This option involves frequent exams as well as blood and imaging tests to monitor your condition. Because of the side effects associated with follow-up treatments such as chemotherapy and radiation therapy (adjuvant therapies), most doctors think watchful waiting is a legitimate treatment option.

If you are diagnosed with a stage I seminoma or nonseminoma (NSGCT), you may have a choice for your next course of treatment. It is important to understand that each treatment option, including watchful waiting, has its own risks. Ask your doctor to fully explain these potential risks and various outcomes so that you can be an informed, active participant at every stage of your treatment. For more information, see:

Which treatment should I have for stage I seminoma?
Which treatment should I have for stage I nonseminoma?

If it is not treated during its early stages, testicular cancer may spread (metastasize) beyond the testes and regional lymph nodes to more distant lymph nodes and organs. Areas that may be affected include the lungs, liver, brain, and bones. Testicular cancer that has metastasized is harder to cure than early-stage cancer, though cure is still possible and in many cases likely. Treatment for advanced-stage testicular cancer may include more invasive surgery and more intensive chemotherapy or radiation therapy.
You may experience a wide variety of emotions after being diagnosed with testicular cancer, including denial, anger, and grief. There is no “normal” or “right” way to react to a diagnosis of cancer. There are many ways you can manage your emotional reaction to testicular cancer. You may find that talking with family and friends helps. Some men may find that spending time alone is helpful.

If your emotions are interfering with your ability to make decisions about your health, talk with your doctor. You may also contact your local hospital or American Cancer Society chapter to help you find a support group. Talking with other people who have had similar feelings can be very helpful.
Ongoing treatment

Regardless of the therapy you choose to treat your testicular cancer, it is important to receive follow-up care, which may lead to early identification and management of recurrent cancer (cancer that comes back). Your regular follow-up program may include:

* Physical exams.
* Imaging tests, including X-rays, CT scans, and MRIs.
* Blood tests, to check tumor marker levels. Stable or increasing tumor marker levels after treatment may mean your cancer is still present or has returned and that further treatment is needed.

A diagnosis of testicular cancer means that you will be seeing your doctor regularly for years to come, so it’s a good idea to develop a relationship based on trust and the sharing of information. Your doctor may give you some advice on changes to make in your life to help treatment be successful.
Treatment if the condition gets worse

Testicular cancer that has come back (recurred) may be discovered during a physical exam, through an imaging test, or as a result of increasing tumor marker levels. Unlike other types of recurrent cancer, recurrent testicular cancer is often cured, especially if it has spread only to the lymph nodes in the pelvis, abdomen, or lower back and pelvis (retroperitoneum). Recurrent testicular cancer may be treated with one or a combination of the following treatments:

* Chemotherapy, including cisplatin, etoposide, and bleomycin
* Surgery, to remove any involved lymph nodes or treat other areas where the cancer has spread (metastasized)
* Radiation therapy

In many cases of recurrent testicular cancer, chemotherapy treatment is followed by surgery to remove any remaining cancer as well as tissue damaged as a result of the chemotherapy.
What to think about

Infertility. Some cancer treatments raise your risk of infertility. Unless you are sure you won’t want to father a child in the future, talk to your doctor about sperm banking before any treatment for testicular cancer.

* Radiation therapy for testicular cancer has been connected with infertility in some men. Although most radiation treatment programs do not permanently affect healthy sperm counts, there is some risk.
* Surgery to remove one cancerous testicle seldom causes infertility, but there is a small risk.
* Nerve-sparing retroperitoneal lymph node dissection (RPLND) seldom causes infertility, but there is a small risk.5

If you have advanced (metastatic) testicular cancer, at some point you may choose to stop curative treatment and focus on care that ensures your comfort (palliative care). It’s hard to decide when to stop medical treatment aimed at prolonging life and shift the focus to palliative care. For more information, see the topics Care at the End of Life and Hospice Care.


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