Treatment for testicular cancer
The three main treatments for testicular cancer are surgery, chemotherapy and radiotherapy.
Your treatment will depend on the stage of the cancer, and whether it’s an NSGCT or seminoma.
Testicular cancer that hasn’t spread outside the testicle
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For some men, surgery to remove the testicle (orchidectomy) may be the only treatment that’s needed.
After surgery, you’ll be asked to come back to the clinic regularly to have the tumour markers measured (if the cancer produces any) and tests. This is called surveillance.
If the cancer comes back, it’ll be picked up early and treatment can cure it. Attending your surveillance appointments is very important. If you move house, make sure the hospital knows your new address.
Men often have treatment with chemotherapy after surgery. This is known as adjuvant treatment. It’s given to reduce the small risk of the cancer coming back.
If you have an NSGCT, you’ll usually have two sessions of adjuvant chemotherapy. The size of the tumour, how it looks under a microscope, and tumour marker levels (if present) help doctors decide if you need adjuvant treatment.
If you have a seminoma, you’ll usually be offered a single dose of adjuvant chemotherapy. Radiotherapy may sometimes be given instead of chemotherapy. Radiotherapy is given to the lymph nodes at the back of the abdomen (retroperitoneal lymph nodes), as this is where the cancer is more likely to come back.
If you need adjuvant treatment, your doctor will explain why it’s advisable for you. Some men may decide not to have adjuvant treatment and to have surveillance instead. They may want to avoid treatment that might not be necessary. Talk this through carefully with your doctor and make sure you have enough information to help you make your decision.
Rarely, if you have an early stage NSGCT, you may be offered surgery to remove the retroperitoneal lymph nodes. This will usually only happen if, following discussion with your oncologist, you decide to avoid adjuvant chemotherapy or surveillance.
Testicular cancer that has spread outside the testicle
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If the cancer has spread outside your testicle, you’ll be given chemotherapy or radiotherapy after your orchidectomy. Treatment may depend on
the exact stage of the cancer.
Your doctors will discuss the treatment they feel is best for you.
If you have an NSGCT that has spread, you’ll usually need to have three or four sessions of chemotherapy. Some men need more intensive chemotherapy depending on the stage of their cancer, certain risk factors and how they respond to the initial chemotherapy. Radiotherapy may sometimes be given if an NSGCT has spread elsewhere in the body.
If you have a seminoma that has spread outside the testicle, treatment is usually with three or four courses of chemotherapy.
Some men may need surgery after chemotherapy to remove the retroperitoneal lymph nodes if they are enlarged.
If testicular cancer comes back
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If testicular cancer comes back, treatment can usually cure it in most men. Even if testicular cancer has spread widely, treatment may still be able to get rid of it.
Treatment and fertility
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Treatments for testicular cancer can sometimes affect your ability to father a child. So, if you need additional treatment after having an orchidectomy you may be advised to store some of your sperm (sperm banking).
How treatment is planned
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In most hospitals, a team of specialists will talk to you about the treatment they feel is best for your situation. This multidisciplinary team (MDT) will include a:
surgeon who specialises in testicular cancers
medical oncologist (chemotherapy specialist)
clinical oncologist (radiotherapy and chemotherapy specialist)
The team may also include other healthcare professionals, such as a dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
The MDT will take a number of factors into account when advising you on the best course of action, including your general health, the type and size of the tumour, and whether it has begun to spread.
Your doctors may ask you to make a choice, such as about having adjuvant treatment or surveillance. Sometimes people find it hard to make a decision like this. Make sure that you have enough information about the different options, what is involved and the possible side effects, so that you can decide on the right treatment for you.
Remember to ask questions about any aspects that you don’t understand or feel worried about. It may help to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with our cancer support specialists.
It often helps to make a list of questions and to take a relative or close friend with you.
Our information on making treatment decisions can help.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its benefits and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need explanations repeated.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you.
The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Even though a number of cancer specialists work together as a team to decide on the most suitable treatment, you may want to get another medical opinion. Most doctors will be happy to refer you to another specialist for a second opinion, if you feel that this will be helpful.
Having a second opinion may mean that the start of your treatment is delayed, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to have a list of questions ready so that you can make sure all your concerns are covered during the discussion.
The benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments because of the side effects that can occur.
Your doctor and nurse will give you information on ways of coping with different side effects. Many side effects can be controlled with medicines.
In men with early testicular cancer, surgery may cure the cancer on its own. Often, adjuvant chemotherapy is given to reduce the risk of the cancer coming back. Some men may be concerned about having adjuvant treatment that they may not need, and which has side effects. Other men may want to have any treatment that reduces the risk of the cancer coming back.
It’s important that you have all the information you need, so that you can make the right choice for you. If early testicular cancer comes back, it can usually still be cured in most men.
Testicular cancer that has spread outside the testicle can still usually be cured. Even if it’s very advanced or comes back after initial treatment, intensive chemotherapy can be given with the aim of curing the cancer.
Rarely, very advanced testicular cancer may not respond well to treatment, or may continue to come back despite treatment. Treatment can be given to help control the cancer, and improve symptoms and quality of life. Occasionally this may have little effect on the cancer, and men will have side effects without the benefit of treatment.
Making decisions about treatment in these circumstances is always difficult, and you may need to talk it over with your doctor and family. If you choose not to have treatment for the cancer, you can still be given treatment to control any symptoms.