Treatment
Treatment for testicular cancer depends on the stage of the disease, but often consists of surgery, radiation therapy, and/or chemotherapy. Here are some procedures your doctor may recommend to treat testicular cancer.
Surgery
Surgical removal of the testicle is usually the primary treatment for testicular cancer. Your doctor may recommend adjuvant radiation therapy or chemotherapy after surgery, depending on the stage of your disease. Your doctor may also recommend surgery to remove your lymph nodes or surgery to preserve testicular function. Here are some of the surgical procedures your doctor may recommend:
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Orchiectomy
An orchiectomy is surgery to remove the entire testicle through an incision in your groin. Your doctor will also remove the spermatic cord and tie it off to prevent the cancer from spreading. Your doctor will usually send the entire specimen to the lab to determine if it is cancerous and if so, the stage of the disease.
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Retroperitoneal lymph node dissection (RPLND)
For nonseminomas, your doctor may recommend this surgical procedure to remove the lymph nodes in the abdomen. Your doctor may perform an RPLND at the same time as an orchiectomy, or as a second procedure. Sometimes this can be laparoscopically or with the assistance of a robot.
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Nerve-sparing surgery
Your doctor may use nerve sparing techniques to prevent damage to the delicate nerves surrounding the abdominal lymph nodes. Preserving these nerves will help you maintain normal sexual function and ejaculation after surgery.
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Reconstructive surgery
You may decide you want reconstructive surgery to make your scrotum look and feel more normal after an orchiectomy. Your doctor will implant a prosthetic testicle into your scrotum. This procedure is usually done at the same time as an orchiectomy.
Other Therapies
Your doctor may also recommend any of the following treatments:
Radiation Therapy
Radiation therapy uses waves of high-energy rays produced by a machine to kill cancer cells. Doctors often give radiation therapy to treat seminomas, as they are very sensitive to radiation. Nonseminomas are more resistant to radiation therapy, and are usually treated with surgery and chemotherapy.
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Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors commonly give chemotherapy for advanced testicular cancer that has spread to other organs or use it in conjunction with surgery to kill any remaining cancer cells. Doctors often treat testicular cancer with dose-dense chemotherapy, in which they administer higher dosages more frequently to give the cancer cells less time to recover.
The most frequently used chemotherapy combinations for testicular cancer are:
BEP: Blenoxane® (bleomycin), Etopophos® or Vepesid® (etoposide), and Platinol® (cisplatin)
EP: Etopophos® or Vepesid® (etoposide) and Platinol® (cisplatin).
Active Surveillance
Active surveillance or watchful waiting may be an option for some stage I testicular cancers where tumor markers return to normal levels after surgery to remove the testis. Active surveillance entails monitoring the cancer closely with physical exams, tumor markers tests, and CT scans to see if the cancer returns. Testing is usually more frequent for nonseminomas, since they are the more aggressive form of testicular cancer. If any of these tests indicates a possible recurrence, your doctor will recommend more active treatment.
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Stem Cell Transplantation
This treatment is used for patients whose cancer has come back or did not respond to prior chemotherapy. High doses of chemotherapy are used to destroy normal cells as well as cancer cells, so your doctor will collect stem cells from your blood before treatment. After treatment, your doctor will give you back your healthy stem-cells to help your body form new, healthy blood cells.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
