Testicular Cancer: Treatment Options

How is it treated?

Treatment options for Testicular Cancer (like all cancers) vary with the stage the disease is in. Some form of surgery is almost always part of the treatment. If the cancer is localized in the testicle, then the surgery can be a simple procedure. However, the surgery may be more extensive if the cancer has spread to surrounding tissue. Surgery is often combined with radiation therapy or chemotherapy to kill cancer cells that were not removed during the operation. Treatment options are different for each individual case, but there are several common procedures listed below. The information presented is intended to provide patients with treatment information that they can use in discussing treatment options with their physician.

Surgery for Testicular Cancer

• Radical Inguinal Orchiectomy - This surgery involves the removal of a testicle. An incision is made through the groin so that the testicle can be drawn in from the scrotum. A cut is then made through the spermatic cord, which attaches the testicle to the body. It is possible for cancer cells from the testicle to break off and spread during this surgery. Therefore, special techniques are used during surgery to minimize this risk.
  
  
• Retroperitoneal Lymph Node Dissection - This surgery involves the removal of the lymph nodes in the groin area. In more advanced stages of Testicular Cancer, some cancer cells may spread to these surrounding lymph nodes. This procedure can be combined with a radical inguinal orchiectomy or performed in a later surgery. A large incision is normally made in the abdomen to access the affected area.
  

Other treatments for Testicular Cancer

• Radiation Therapy - In some cases X-rays can be used to kill or shrink cancer cells at the site of the tumor. A machine, such as a linear accelerator or cobalt apparatus, is used to administer the radiation. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread. Radiation therapy is a type of localized treatment, which means that it affects only a specific area of the groin.
  
  
• Chemotherapy - Drugs are administered by mouth or injection to kill the cancer cells. The drugs enter the blood stream and can, therefore, reach areas of the body where the cancer may have spread. Chemotherapy is a type of generalized treatment, which means that it affects all areas of the body.
  
  
• Clinical Trials - There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects.

Possible Side Effects From Surgical Treatment

• Radical Inguinal Orchiectomy - side effects differ depending on whether one or both testicles are removed.
  
  
  • Removal of one testicle - Men that have had a testicle removed still have normal sexual function including fertility. The scrotum will look different after the removal of a testicle, but a silicon testicular prosthesis can restore the regular appearance.
    
    
  • Removal of both testicles - If both testicles are removed, then a man can still have sexual relations, however, he becomes infertile. Men who still wish to have children often visit a sperm bank before surgery so that some of their sperm can be frozen and saved.
    
    
• Retroperitoneal Lymph Node Dissection - This is a major operation and some patients experience temporary complications such as wound infection or bowel obstruction. There is also a risk of damaging the nerves that control ejaculation and sexual function. However, new nerve-sparing techniques are now used that prevent nerve damage 98% of the time.
  

Possible Side Effects from Non-Surgical Treatments

*Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy - Special precautions are taken to minimize the risk of affecting the healthy testicle.
  
  • Nausea, vomiting, diarrhea
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
  
  
• Chemotherapy
  
  • Infertility - normally occurs for about two years after chemotherapy is stopped
    
  • Nausea and vomiting - Loss of appetite
    
  • Loss of hair
    
  • Mouth sores
    
  • Increased susceptibility to infection
    

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