Treating testicular cancer

Thursday 1 September, 2016

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On this page: Surveillance  | ChemotherapyRadiotherapyRetroperitoneal lymph node dissection | Palliative treatment | Bradley's story | 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 any lymph nodes involved
  • whether the cancer has spread to other parts of your body. If testicular cancer does spread, it most commonly spreads to the lymph nodes in the pelvic and lower abdominal regions.

In almost all cases, an orchidectomy is done to remove the affected testicle. Additional treatments for testicular cancer may include chemotherapy, radiotherapy or a combination of treatments to kill any remaining cancer cells or prevent the cancer from coming back.

Further surgery may be required if the cancer does not respond to chemotherapy (see retroperitoneal lymph node dissection).

Sperm banking

Chemotherapy, radiotherapy and RPLND can cause temporary or permanent infertility. If you would like to have children in the future, ask your doctor for a referral to a fertility specialist before treatment starts, as you may be able to store sperm for later use. For more information about sperm banking, see Fertility and Cancer or call Cancer Council 13 11 20.

Surveillance

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

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

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 recurrence, so surveillance will be tailored to your circumstances.

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

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. If the cancer is contained in the testicle, it can usually be treated with surgery alone and chemotherapy is not needed.

This treatment may be given:

  • if the cancer has spread outside your testicle
  • after 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.

There are many types of chemotherapy drugs. Some men are given a drug called carboplatin, which is often used for early-stage seminoma cancer after surgery. Other drugs commonly used in testicular cancer are bleomycin, etoposide and cisplatin. When these three drugs are used together, it 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 for a period of time and then have a rest period of a few weeks before starting a new cycle.

Treatment schedules vary – your doctor will give you more information. You will probably have to visit the hospital as an outpatient each time you have chemotherapy.

For ways to prevent or reduce the side effects of chemotherapy, see below. For more information see Understanding Chemotherapy or call Cancer Council 13 11 20.

Side effects of chemotherapy

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. 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 or nurse about any side effects you have and ways to manage them.

Tiredness

Most men feel tired during chemotherapy, particularly as treatment progresses.

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 nearest hospital emergency department.

Nausea and vomiting

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

Constipation

Medication taken to prevent nausea and vomiting can cause constipation. Your medical team can prescribe something for this.

Hair loss

Chemotherapy often causes hair loss from the head and body, but it usually grows back once treatment is over.

Erection problems

Chemotherapy can affect erections, but this is usually temporary. You may also find you have a lower sex drive (libido). See 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.

Peripheral neuropathy

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

Ringing in the ears

Some chemotherapy drugs can cause short-term ringing or buzzing in the ears, known as tinnitus.

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, you will have regular check-ups after treatment to test for cancer.

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 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 – it may be 6–12 months.

Although chemotherapy drugs and radiation can affect sperm production and damage sperm, you may still be fertile and able to father a child. As the treatments can harm an unborn baby, it is important that your partner does not become pregnant while you’re having treatment and for a period of time afterwards as advised by your doctor. Some men want to have children after treatment. See more information about fertility.

Radiotherapy

Radiotherapy uses high-energy x-rays to kill cancer cells or damage them so they cannot multiply. It is sometimes given to men with seminoma cancer after surgery to prevent the cancer from coming back or to destroy any cancer cells that may have spread.

Treatment is carefully planned to make sure as many cancer cells as possible are destroyed while causing the least possible harm to normal tissue. During a radiotherapy session, you will lie under a machine called a linear accelerator, which directs the x-ray beams at the cancer site.

The unaffected testicle may be covered with a lead barrier to help preserve your fertility.

Radiotherapy is painless and can’t be felt. The treatment itself takes only a few minutes, but each session may last 10–20 minutes because of the time it takes the radiation therapists to set up the equipment and place you in the correct position. 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.

Side effects of radiotherapy

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

Skin reaction

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

Fatigue

This can build up over time. 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.

Stomach problems

The radiotherapy area may include your abdomen and this may cause stomach pain, nausea and bloating. Your doctor may prescribe medication to prevent these symptoms from occurring, or to treat them if they do occur.

Bowel problems

Bowel irritations, including diarrhoea and cramping, are common. Medication and watching what you eat can help. Call 13 11 20 for 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.

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 fertility. Speak with your doctor about sperm banking before starting radiotherapy.

Secondary cancers

Rarely, men who have radiotherapy for seminoma cancer are at a slightly increased risk of developing secondary cancers in the area of the body exposed to radiation. If you do have radiotherapy, you will have regular check-ups after treatment to test for cancer.

You will see your radiation oncologist at least once a week 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 side effects. For more information see Understanding Radiotherapy or call Cancer Council 13 11 20.

Retroperitoneal lymph node dissection

In some cases, an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) is done to remove lymph nodes containing any remaining cancer cells or other abnormal tissue.

Men with non-seminoma cancer

May have an RPLND if scans after chemotherapy show remaining cancer cells. An RPLND will also detect whether another type of abnormal tissue called mature teratoma is present. Teratoma is not cancer, but it may turn into cancer later on, so it should be removed.

Men with seminoma cancer

An RPLND is usually not needed as the cancer cells in the lymph nodes can be destroyed through chemotherapy or radiotherapy. However, some men with more advanced seminoma cancer have this procedure.

An RPLND can be done in two ways, depending on the stage of the cancer: 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 surgery). During the operation, your organs are moved out of the way and the affected lymph nodes are removed.

Side effects of RPLND

It can take many weeks to recover from an RPLND – at first, you will probably be very tired and may 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.

An 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 an 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.

Palliative treatment

Sometimes cancer that has spread to other parts of the body cannot be cured. Palliative treatment helps to reduce symptoms of cancer without trying to cure the disease. It can be given at any stage of advanced cancer to improve quality of life. It is not just for people who are about to die and does not mean you have given up hope. Rather, it is about living for as long as possible in the most satisfying way you can.

As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.

For more information see Understanding Palliative Care or call Cancer Council 13 11 20.

Bradley’s story

"I was 24 when I started feeling lethargic and developed a lot of pimples on my back, which was unusual for me. My left testicle was also increasing in size and felt hard. At first I thought it was some kind of hormonal change but as the testicle was becoming heavy and uncomfortable, I told my dad. He took me straight to the doctor, who did a physical examination and sent me for an ultrasound.

"After the ultrasound, the technician said to see my doctor right away. So my dad and I went back to my GP, and he told me I had testicular cancer. I was shocked and emotional, but tried to keep calm.

"The GP referred me to a urologist who said the testicle would need to be removed. Within 12 hours of seeing him I’d had the operation. It was sent to the lab for testing and it was confirmed as stage I seminoma testicular cancer. I had a little inflammation but otherwise I felt good. I only had to stay in hospital overnight.

"A month after the surgery I had two rounds of chemotherapy in case the cancer spread. The chemotherapy made me feel tired and left a funny taste in my mouth. These side effects passed quickly and it helped to drink a lot of water. My urologist suggested I store some sperm before the chemotherapy because there was a small chance the treatment would make me sterile.

"I saw my doctor every 3–6 months and had blood tests as well as a CT scan and ultrasound. I also examined the other testicle regularly for any hardness. It’s been five years now and there’s been no recurrence.

"My life has now returned to normal and I don’t really think about the cancer much."

Key points

  • Your medical team will advise you on treatment based on the type of testicular cancer, its stage, your general health and your preferences.
  • After surgery to remove the testicle (orchidectomy), 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 surveillance.
  • Some men also have chemotherapy, radiotherapy, surgery or a combination of these treatments.
  • Chemotherapy is the use of drugs to kill cancer cells or slow their growth. Different drugs may be used – one common combination is called BEP chemotherapy.
  • Most 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.
  • Common side effects of radiotherapy include fatigue and abdominal pain. These usually disappear 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).
  • If the cancer has spread, palliative treatment may help control symptoms and stop the cancer from spreading further. It can include treatments such as chemotherapy or medication.

Reviewed by: A/Prof Declan Murphy, Urologist, Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; A/Prof Joseph McKendrick, Medical Oncologist, Eastern Oncology, Eastern Health and Monash University, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia, WA; Ben Peacock, Consumer; and Deb Roffe, Cancer Council Nurse, Cancer Council SA.