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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate in the bloodstream and can reach cancer cells anywhere in the body.
The drugs most commonly used to treat testicular cancer are cisplatin|, etoposide| and bleomycin|. This is known as BEP chemotherapy|. Other combinations of drugs are also used depending on the stage of the cancer, or if it’s come back after treatment.
Chemotherapy for testicular cancer is given:
Adjuvant chemotherapy for men with early (stage 1|) teratoma is usually two cycles of BEP. A cycle usually takes three weeks. Men with early seminoma are usually given a one-off treatment with a drug called carboplatin|.
If testicular cancer has spread outside the testicle, or comes back during surveillance|, you’ll usually need three or four cycles of BEP. You may be asked to join a clinical trial| that is trying to find out more about different ways of giving BEP or different combinations of chemotherapy drugs.
If testicular cancer doesn’t completely respond to BEP, or comes back again, more intensive chemotherapy is usually given. Some men, depending on the stage of their testicular cancer|, are given more intensive chemotherapy straight away.
Some drug combinations that may be used are:
We have more information on individual chemotherapy drugs|, as well as combination chemotherapy regimens|, that you may find useful.
Occasionally high-dose chemotherapy with stem cell support is given in a clinical trial.
High-dose chemotherapy with stem cell support| allows you to have much higher doses of chemotherapy than usual to try to destroy all the testicular cancer cells. Before high-dose treatment, cells in your blood (called stem cells) are taken from you and stored. These stem cells help you to produce new blood cells, to replace the ones that the high-dose chemotherapy damages.
Shortly after high-dose treatment, your stem cells are given back to you through a drip into a vein (like a blood transfusion). They make their way back to the bone marrow (where blood cells are made) and start to produce blood cells again.
This is an intensive treatment and it means staying in hospital for several weeks. You’ll need a lot of nursing and medical care until you’ve recovered and your blood cells are improving.
The chemotherapy drugs are given into a vein (intravenously), as injections or drips (infusions). Intravenous chemotherapy can be given through a small tube (cannula) in your arm or through a soft plastic tube called a central line or PICC line. A central line is put into a vein in your chest under a general or local anaesthetic.
A central line
View a large version of the image here|
Instead of a central line, a tube may be put into a vein in the bend of your arm. This is known as a PICC line|.
Chemotherapy is given in cycles of treatment. A cycle often takes three weeks. If you’re having BEP you’ll usually spend 3–5 days in hospital as a day patient, or sometimes stay overnight. This is followed by weekly outpatient visits to be given the rest of the treatment. Other combinations of chemotherapy drugs may involve more time in hospital and having the drugs more often. Your doctor or nurse will tell you how many cycles of treatment are planned for you and explain how you’ll be given your chemotherapy.
Chemotherapy drugs can cause side effects, but these can often be controlled well with medicines. Your doctor or specialist nurse will tell you more about what to expect. Usually most of these side effects improve and go away when your treatment is over.
Chemotherapy can reduce your number of white blood cells, making you more likely to get an infection|.
Chemotherapy may reduce the number of red blood cells (haemoglobin) in your blood. A low level of red blood cells is known as anaemia, which can make you feel very tired and lethargic. You may also become breathless.
Anaemia can be treated with blood transfusions|. This should help you to feel more energetic and ease the breathlessness.
Chemotherapy can also reduce the production of platelets, a type of blood cell which helps the blood to clot. If the number of platelets in your blood is low you’ll bruise very easily and may bleed heavily from even minor cuts or grazes
Some of the drugs used to treat testicular cancer can make you feel or be sick|, but there are very effective anti-sickness drugs (anti-emetics) to prevent or control this. If the sickness isn’t controlled or continues, even with anti-sickness treatment, let your doctor know. They can prescribe other medicines that may be more effective.
It’s common to feel tired| during chemotherapy and how tired you feel will depend on how much treatment you have. If you have a lot of chemotherapy, it can last for several months or more after your treatment has finished.
Some chemotherapy drugs can make your mouth sore| and cause small ulcers.
Our section on eating well| has some useful tips on coping with eating problems|. We also have information about looking after your mouth during chemotherapy|.
It’s common to lose your hair with chemotherapy treatments such as BEP. Carboplatin (used to treat seminoma) doesn’t usually cause hair loss. Your hair will usually start to fall out 2–3 weeks after your first treatment. When your treatment finishes your hair will start to grow again.
Some men shave their heads once they notice that their hair is starting to fall out. You can cover up using different hats (baseball caps, beanies, etc) or with bandanas or scarves. Choose something that suits your personal style and that you're comfortable with. You'll probably end up with a range of things that you can wear depending on the occasion and the weather.
Your doctor or nurse can arrange for you to see a wig specialist if you want to use a wig. If you're an inpatient, or are on income support, you can get a free wig from the NHS.
There are more tips in our section on coping with hair loss|.
Bleomycin sometimes causes lung problems, which may make you breathless| and give you a cough. This is usually mild, but if it becomes a problem your doctor may need to stop or change the drug. Tell your doctor or nurse if you feel breathless.
If you need an operation after having had bleomycin, always tell the anaesthetist that you’ve had bleomycin treatment. If sub-aqua diving is an activity you’re involved in, you may need to be careful about it after treatment with bleomycin, so talk to your doctor about this.
Cisplatin can cause ringing in the ears (tinnitus) and might affect your ability to hear some high-pitched sounds. Tinnitus usually improves after treatment but changes to your hearing are often permanent. Always let your doctor know if you have any changes to, or problems with, your hearing. They will monitor this closely and arrange hearing tests if necessary.
This is due to the effect of cisplatin on the nerves. It’s known as peripheral neuropathy|. You may notice that you have difficulty fastening buttons or doing similar fiddly tasks. Your hands and feet may also become more sensitive to the cold. Tell your doctor if you notice any of those symptoms.
These problems usually disappear gradually after treatment ends, although sometimes damage can be permanent.
Chemotherapy (in particular cisplatin) can affect your kidneys so you’ll have regular blood tests to check how well they’re working. You’ll also be given lots of fluid as a drip before and after having cisplatin.
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated with drugs that thin the blood. Your doctor or nurse can give you more information.
It’s not advisable to father a child while having chemotherapy as the drugs may harm an unborn baby. So it’s important to use effective contraception during your treatment. There’s no evidence that chemotherapy harms children fathered after treatment is over. However, doctors usually advise that you avoid fathering a child for about a year afterwards. You can talk this over with your doctor or specialist nurse.
It’s not clear if or how much chemotherapy comes through in the semen. So if you’re having sex within 48 hours after chemotherapy, use a condom to protect your partner.
Chemotherapy for men with testicular cancer commonly causes infertility during treatment and for a time after. This is usually temporary but your doctor will advise that you consider storing sperm| before having treatment. The rate at which the sperm count recovers varies from person to person, but it generally returns to normal from around 18 months or so after treatment. In men having high-dose chemotherapy, the risk of infertility is much higher and infertility is often permanent.
Some men with testicular cancer have a low sperm count before they start treatment. Treatment with chemotherapy can sometimes improve sperm production.
Our section on chemotherapy| discusses the treatment and its side effects in more detail.
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If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.