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.

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.

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.

Key points