Treating testicular cancer

Friday 1 August, 2014

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On this page: Surveillance policy | ChemotherapyRadiotherapyFurther surgery | Palliative treatment | Key points


Your medical team will advise you on the best treatment for you. They will consider:

  • your general health
  • the type of testicular cancer you have
  • the size of the tumour
  • the number and size of lymph nodes involved
  • whether the cancer has spread to other parts of your body.

In almost all cases, except for men diagnosed at an advanced stage, an orchidectomy is done to remove the affected testicle. Additional treatment for testicular cancer may include chemotherapy, radiotherapy or a combination of treatments.

Surveillance policy

If you had an orchidectomy and the cancer was completely removed along with your testicle, you may not need further treatment. Instead, your doctor may monitor you with regular blood tests (checking tumour markers), chest x-rays and CT scans for at least five years. This is called a surveillance policy.

Surveillance can detect if there is any cancer remaining (residual cancer). It can also help determine if the cancer has come back.

The number of check-ups and scans will depend on the type of testicular cancer you have – seminoma and non-seminoma cancers have different patterns of relapse, so surveillance is tailored for you. 

It’s important to adhere to the surveillance policy outlined by your doctor. Though it may be tempting to skip appointments if you are feeling better or if you were diagnosed with early-stage cancer, surveillance is more likely to find the cancer early if it comes back.

"Surveillance is just like having regular check-ups. I was seen every four months for the first year, every six months from years 1 to 3, then every 18 months." — Mike

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim of treatment is to destroy cancer cells, and cause the least possible damage to healthy cells.

This treatment may be given:

  • if the cancer has spread outside your testicle
  • together with surgery or, less commonly, with radiotherapy (adjuvant treatment), if there is a moderate risk of the cancer spreading or returning
  • as the primary treatment if the cancer has spread to other parts of your body (stage 3 cancer)

There are many types of chemotherapy drugs. Some men are given a drug called carboplatin, which is often used for earlystage seminoma cancer as adjuvant chemotherapy. Other drugs commonly used in testicular cancer are bleomycin, etoposide and cisplatin. When used together, this is called BEP chemotherapy. 

Chemotherapy is administered into a vein (intravenously) through a drip. Bleomycin may also be given by injection into a muscle (intramuscularly). In either case, chemotherapy is given in cycles, which means you will receive the drugs and then have a rest period of about 21 days before starting a new cycle. Most men have 2–3 cycles of BEP, but treatment varies from patient to patient.

You will probably have to visit the hospital as an outpatient each time you have chemotherapy. This is generally for five days out of every three weeks, and one day per week for the other two weeks of the cycle. 

In most cases, chemotherapy is a successful treatment for testicular cancer. For information see our chemotherapy section.

Chemotherapy side effects

Chemotherapy can affect the healthy fast-growing cells in your body, such as hair cells or cells lining the mouth and stomach, causing side effects.

Everyone reacts differently to chemotherapy, so the side effects you experience will depend on the drugs you receive. Some men don’t experience any side effects, while others have a few.

Side effects are usually temporary, and medication can often help reduce your discomfort. Talk to your doctor about any side effects you have and ways to manage them.

Tiredness

Most men feel tired during chemotherapy, particularly as treatment progresses. You may also find you have a lower sex drive (libido). See more information on fatigue.

Low white blood cell count

About a week after a treatment session, your white blood cell levels may drop, making you more prone to infections. If you feel unwell or have a fever higher than 38°C, call your doctor immediately or, if after hours, go to the hospital Emergency department.

Nausea and vomiting

It is common to feel ill or vomit. However, anti-nausea medication can prevent or reduce this feeling. It is available in many forms, including suppositories, oral tablets and wafers that dissolve on the tongue. Tell your medical team if you feel nauseated.

Constipation

Medication taken to prevent nausea and vomiting can cause constipation. Your medical team can give you laxatives for this.

Hair loss

Chemotherapy often causes patients to lose their body and head hair, but it grows back once treatment is over. See more information on hair loss.

Neuropathy

Some drugs affect the nerves, causing numbness or tingling in fingers or toes. This is called peripheral neuropathy. It typically improves after treatment is finished.

Ringing in the ears

Ringing or buzzing in the ears, known as tinnitus, may occur as a short-term side effect. 

Erection problems

Chemotherapy can affect erections, but this is usually temporary. See more information about sexuality.

Lower sperm production

The drugs may reduce the number of sperm you produce and their ability to move (motility). This can cause temporary or permanent infertility. Speak with your doctor about sperm banking before starting chemotherapy.

Breathlessness, cough or unexplained symptoms

Some drugs can damage the lungs or kidneys. You may have lung and kidney function tests to check the effects of the drugs on your organs before and after treatment.

Risk of other cancers

Men who have chemotherapy for testicular cancer are at a slightly higher risk of developing secondary leukaemia. This is extremely rare, so the benefit of receiving treatment outweighs this risk. However, your doctors will do regular check-ups to monitor you.

For more information call Cancer Council 13 11 20 or see our chemotherapy section.

You may have surveillance after chemotherapy treatment. Regular tests and scans will monitor you to check if the cancer has come back.

Using contraception during treatment

Chemotherapy drugs may remain in your body for a few days after treatment, and they can be passed into body fluids, such as urine and semen.

If you have any type of sex within seven days after a treatment session, protect your partner from your body fluids by using a condom. Your doctor or nurse can give you more information about how long you need to use this protection.

Although chemotherapy can affect sperm production, you may still be fertile and able to cause pregnancy. As chemotherapy drugs can harm an unborn baby, it is important that your partner does not become pregnant during the time you’re having chemotherapy treatment.

Some men want to have children after treatment. See more information about fertility.

Radiotherapy

Radiotherapy uses x-ray to damage or kill cancer cells, however this treatment is not commonly used to treat testicular cancer. It was used to treat men with seminoma cancer, but this is becoming less common. Men with non-seminoma cancer are not usually treated with radiotherapy.

Radiotherapy is sometimes given after surgery to prevent the testicular cancer from coming back or to destroy any cancer cells that may have spread. Testicular cancer most commonly spreads to the lymph nodes in the pelvic and lower abdominal region. 

Treatment is carefully planned to make sure as many cancer cells as possible are destroyed while causing the least possible harm to your normal tissue.

The radiation oncologist or radiation therapist may mark your skin with a special ink to make sure the radiation is directed at the same place on your body every time you receive treatment. Although the ink is permanent, the mark is very small (the size of a freckle).

During treatment you will lie under a machine called a linear accelerator, which directs the x-ray beams at the cancer. The unaffected testicle may be covered with a lead barrier to help preserve your fertility.

Treatments only take a few minutes, but the initial appointment to see the radiation oncologist and set up the machine may take a few hours. Most men have outpatient treatment sessions at a radiotherapy centre from Monday to Friday for 2–4 weeks. Your doctor will advise you on the number of sessions you need to have.

You may have surveillance after radiotherapy treatment. Regular tests and scans will monitor you to check if the cancer has come back. 

Radiotherapy side effects

Radiotherapy most commonly causes skin reactions, fatigue and stomach problems. However, side effects usually disappear within a few days of finishing treatment.

Your doctor will check in with you at least weekly to monitor and treat any side effects during the course of your treatment. You can also talk to a nurse if you are concerned about any side effects.

Skin reaction

The skin in the treatment area may become red or irritated. Moisturising cream, such as sorbolene, should be applied to the skin when treatment starts – talk to your medical team about any other products they recommend.

Fatigue

Tiredness can be a major challenge. Plan your activities during the day so you can rest regularly. It may also help to talk to your family, friends or employer about how they can help you. See more information on fatigue.

Stomach problems

The radiotherapy area will include your abdomen and this may cause stomach pain, nausea and bloating (dyspepsia). Your doctor may prescribe medication to prevent these symptoms from occurring.

Bowel problems

Bowel irritations, including diarrhoea, are common. Medication and watching what you eat can help. See more information about nutrition and cancer.

Hair loss

You may lose pubic and abdominal hair in the treatment area. After treatment, your hair will usually grow back. See more information on hair loss.

Bladder irritation

Your bladder and urinary tract may become irritated and inflamed. Drinking plenty of fluids will help, but you should avoid alcoholic or caffeinated beverages, as they can irritate the bladder further. 

Infertility

Radiotherapy may cause reduced sperm production or damage to sperm. This may be temporary or permanent – see more information about radiotherapy and fertility. Speak with your doctor about sperm banking before starting radiotherapy.

Secondary cancers

Men who have radiotherapy for seminoma are at a slightly increased risk of developing secondary cancers in the radiotherapy field. This is the area of the body exposed to radiation, and can include the stomach and pancreas.

This is rare, however it is one of the reasons that radiotherapy is now used less commonly, particularly for stage 1 seminoma. If you do have radiotherapy, your doctors will do regular check-ups to monitor you after treatment. 

For more information call Cancer Council 13 11 20 or see our radiotherapy section.

Further surgery

If the cancer has spread to the lymph glands (lymph nodes) in your abdomen, you may have an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) to remove them.

Men with non-seminoma may have a RPLND after chemotherapy has finished. This is done to check whether there is any remaining cancer, or another type of abnormal tissue called mature teratoma.

Teratoma is not cancer, but it may turn into cancer later on, so it should not be left in the body.

Men with seminoma usually don’t have this procedure as the cancer cells in their lymph nodes can be destroyed through radiotherapy or chemotherapy. However, some men with more advanced seminoma have a RPLND.

This surgery can be done in two ways, depending on the stage of the cancer and the experience of the surgeon: a large incision may be made from the breastbone (sternum) to below the bellybutton (an open procedure), or the surgeon may make a smaller cut and insert the surgical tools (laparoscopy or keyhole technique).

During the operation, your organs are moved out of the way and the affected lymph nodes are removed. This is sometimes referred to as ‘cherry picking’.

The procedure can take several hours, depending on how many lymph nodes need to be removed.

RPLND side effects

It can take many weeks to recover from a RPLND – at first, you will probably be very tired and not be able to do as much as you are used to.

The main side effects are abdominal pain and tenderness. Tell your doctor or nurses if you are in pain, as they can prescribe medication to make you more comfortable.

A RPLND may also damage the nerves that control ejaculation. This can cause a problem known as retrograde ejaculation, which is when sperm travels backwards into the bladder, rather than forwards out of the penis. Although this is not harmful to the body, it causes infertility.

If having children is important to you, it’s advisable to store some sperm before the RPLND. It may also be possible for your surgeon to use a nerve-sparing surgical technique to protect the nerves that control ejaculation. Talk to your doctor for more information about this procedure. 

Palliative treatment

Palliative treatment helps to improve people’s quality of life by alleviating symptoms of cancer without trying to cure the disease.

Treatment can help with managing any pain, stopping the spread of cancer and managing symptoms. It may include radiotherapy, chemotherapy or other medication.

Call Cancer Council 13 11 20 for more information about palliative care and advanced cancer.

Key points

  • Your medical team will advise you on treatment based on the type of testicular cancer, its stage, your general health and what you want.
  • If you had an orchidectomy to remove the testicle, you may not need any further treatment. Instead, your doctor will monitor you with regular blood tests, chest x-rays and CT scans for about five years. This is called a surveillance policy.
  • Men who have further treatment may have chemotherapy, radiotherapy, surgery or a combination.
  • Chemotherapy is the use of drugs to kill or slow cancer cell growth. Different drugs may be used – one common combination is called BEP chemotherapy.
  • Side effects of chemotherapy are temporary. They include a risk of infection, fatigue, nausea, hair loss and erection problems.
  • Radiotherapy uses x-rays to damage or kill cancer cells. It is not used commonly, but it may be used to treat men with seminoma cancer.
  • Some side effects of radiotherapy include fatigue and abdominal pain. This usually disappears soon after treatment finishes.
  • If the cancer has spread to the lymph nodes in the abdomen, you may have an operation to remove the affected nodes after chemotherapy is finished. This is a retroperitoneal lymph node dissection (RPLND).
  • Palliative treatment may help control symptoms and stop the cancer spread. It can include treatments such as chemotherapy or medication.

Reviewed by: Dr Peter Heathcote, Senior Urologist, Princess Alexandra Hospital, QLD; Gregory Bock, Cancer Nurse Coordinator Urology, WA Cancer and Palliative Care Network, WA; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; A/Prof Howard Gurney, Head of Clinical Research for Medical Oncology, Westmead Hospital, Director of Clinical Trials and Medical Oncology, Macquarie University, NSW; Carmen Heathcote, Cancer Council Queensland Helpline Operator, QLD; Aaron Likely, Consumer; David Moser, Consumer; and Dr Marketa Skala, Radiation Oncologist, W.P. Holman Clinic, TAS.

Updated: 01 Aug, 2014