Your medical team will advise you on the best treatment for you, based on your general health, the type of testicular cancer you have, the size of the tumour, the tumour marker levels on your blood test, the number and size of any lymph nodes involved and whether the cancer has spread to other parts of your body.
Active surveillance
If you had an orchidectomy and the cancer was completely removed along with your testicle, you may not need further treatment. Instead, you will have surveillance, with regular blood tests (checking tumour markers), chest x-rays and CT (computerised tomography) scans for five to ten years.
Surveillance can help find if there is any cancer remaining (residual cancer). It can also help work out if the cancer has come back (recurrence). How often you will need the check-ups and scans will depend on whether you had seminoma or non-seminoma testicular cancer. Your doctor will set up a surveillance schedule according to your circumstances, which is important to follow.
Chemotherapy
Chemotherapy is the treatment of cancer with drugs that aim to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. Chemotherapy may be used at different stages of testicular cancer.
- To reduce the risk of recurrence – If you have early testicular cancer that has not spread (stage 1), instead of active surveillance you may be offered chemotherapy after surgery. This is called adjuvant chemotherapy.
- To treat cancer that has spread – If you have stage 2 or 3 testicular cancer, chemotherapy may be recommended after surgery to destroy any cancer cells that have spread. This usually involves 3–4 cycles of chemotherapy.
- Before surgery (neoadjuvant) – Rarely, when the cancer has spread to other parts of the body, chemotherapy may be given before surgery (orchidectomy) to help control the spread and reduce symptoms.
- Treatment after chemotherapy – You may need further surgery to remove any tumours that haven’t completely disappeared after chemotherapy.
There are many types of chemotherapy drugs. Some people are given a drug called carboplatin, which is often used for early-stage seminoma cancer after surgery. Other drugs commonly used for both seminoma and non-seminoma testicular cancer are bleomycin, etoposide and cisplatin. These 3 drugs used together are called BEP chemotherapy.
For more information, see Understanding Chemotherapy.
"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." Bradley
Radiation therapy
Radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. The radiation is usually in the form of focused, high-energy x-ray beams.
Radiation therapy is sometimes given to people with seminoma cancer after surgery to prevent the cancer from coming back or to destroy any cancer cells that may have already spread from the cancer to the lymph nodes.
Treatment is carefully planned to ensure that any remaining cancer cells are destroyed while causing the least possible harm to normal tissue.
For more information, see Understanding Radiation Therapy.
Using contraception during treatment
Even if treatment lowers sperm production, there is still a chance your partner could become pregnant. Because chemotherapy and radiation therapy can damage sperm, you will need to use contraception during treatment and sometimes for some months afterwards to prevent pregnancy. Your doctor will discuss this with you in more detail.
Surgery to remove lymph nodes
In some cases, an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) is done to remove lymph nodes at the back of the abdomen that may contain cancer cells.
- Non-seminoma cancer – Your doctors may recommend an RPLND if scans after chemotherapy show that the lymph nodes have not returned to normal size, as this may mean that they still contain cancer cells.
- Seminoma cancer – Chemotherapy or radiation therapy can usually destroy seminoma cancer cells in the lymph nodes, so an RPLND is rarely used. The operation may be offered for advanced seminoma cancer if there are no other treatment options.
Having an RPLND
An RPLND is a long, complex operation. The standard approach involves open surgery, with a large cut made from the breastbone to below the bellybutton. The surgeon moves the organs out of the way, then removes the affected lymph nodes from the back of the abdomen (the retroperitoneum).
In select cases, some highly trained surgeons may offer robotic (keyhole) surgery where the surgeon inserts surgical instruments through several small cuts in the abdomen with help from a robotic system.
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 pain and tenderness in the belly.
An RPLND may also damage the nerves that control ejaculation. This can cause retrograde ejaculation, which is when semen travels backwards into the bladder, rather than forwards out of the penis. Although retrograde ejaculation is not harmful to the body, it causes infertility.
Palliative treatment
In the rare situation that testicular cancer is so advanced that treatment cannot make it go away, your doctor may talk to you about palliative treatment, which helps to improve people’s quality of life by managing symptoms of cancer without trying to cure the disease.
Many people think that palliative treatment is only for people at the end of their life, but it can help people at any stage of advanced cancer. It is about living for as long as possible in the most satisfying way you can.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, practical, emotional, spiritual and social needs. The team also supports families and carers.
Follow-up appointments
Treatment for testicular cancer usually has a good outcome and the majority of people with early stage cancer will be cured. Only about 2–3% of people who have had cancer in one testicle develop cancer in the other testicle. However, some people have a recurrence of cancer in another part of the body.
If this does happen, treatment will depend on whether the cancer is in the other testicle, where it has spread to, and what type of testicular cancer it is. It’s important to go to all your follow-up appointments, as tests can detect cancer recurrence early.
Question checklist
This checklist may be helpful when thinking about questions to ask your doctor.
- What type of testicular cancer do I have?
- Has the cancer spread? If so, where has it spread? How fast is it growing?
- Are the latest tests and treatments for this cancer available in this hospital?
- What treatment do you recommend? What is the aim of the treatment?
- If I don’t have the treatment, what should I expect?
- How long do I have to make a decision?
- Should I be treated in a centre that specialises in testicular cancer?
- I’m thinking of getting a second opinion. Can you recommend anyone?
- How long will treatment take? Will I have to stay in hospital?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- How will we know if the treatment is working?
- Are there any clinical trials or research studies I could join?
- What are the risks and possible side effects of each treatment?
- Will I have a lot of pain? What will be done about this?
- Can I work, drive and do my normal activities while having treatment?
- Will my fertility be affected? What are my options for preserving fertility?
- Will the treatment affect my sex life?
- Should I change my diet or physical activity during or after treatment?
- Are there any complementary therapies that might help me? After treatment
- How often will I need check-ups after treatment?
- If the cancer returns, how will I know? What treatments could I have?
Key points
The treatment recommended for you will depend on the type of testicular cancer, its stage, your general health and your preferences. Most people have surgery (orchidectomy) to remove the testicle.
After an orchidectomy, if the cancer has not spread, you may not need further treatment. Instead, you will have regular check-ups, blood tests and CT scans. This surveillance has to be continued for 5–10 years. It will help detect any return of the cancer early.
- If the cancer has spread, after an orchidectomy some people may have chemotherapy, radiation therapy, more surgery or a combination of these treatments.
- Chemotherapy uses drugs to kill cancer cells or slow their growth. Most side effects are temporary, but can include a risk of infection, fatigue, nausea, hair loss and erection problems.
- Radiation therapy uses targeted radiation to damage or kill cancer cells. Common side effects include fatigue and stomach pain.
- A retroperitoneal lymph node dissection (RPLND) is an operation to remove lymph nodes from the back of the abdomen. You may have an RPLND if the cancer has spread to these lymph nodes.
- Palliative treatment can be used at any stage of advanced cancer to control symptoms and stop the cancer from spreading further.
Treatment for testicular cancer can cause a range of side effects, but there are ways to manage changes (see Managing side effects).
Understanding Testicular Cancer
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Expert content reviewers:
Dr Benjamin Thomas, Urological Surgeon, The Royal Melbourne Hospital and The University of Melbourne, VIC; A/Prof Ben Tran, Genitourinary Medical Oncologist, Peter MacCallum Cancer Centre, Walter and Eliza Hall Institute of Medical Research and The University of Melbourne, VIC; Dr Nari Ahmadi, Urologist and Urological Cancer Surgeon, Chris O’Brien Lifehouse, NSW; Helen Anderson, Genitourinary Cancer Nurse Navigator, Gold Coast University Hospital, QLD; Anita Cox, Youth Cancer – Cancer Nurse Coordinator, Gold Coast University Hospital, QLD; Dr Tom Ferguson, Medical Oncologist, Fiona Stanley Hospital, WA; Dr Leily Gholam Rezaei, Radiation Oncologist, Chris O’Brien Lifehouse and Royal Prince Alfred Hospital, NSW; Dheeraj Jain, Consumer; Amanda Maple, 13 11 20 Consultant, Cancer Council SA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW.
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The information on this webpage was adapted from Understanding Testicular Cancer - A guide for people with cancer, their families and friends (2023 edition). This webpage was last updated in August 2023.