Chemotherapy for testicular cancer
Some side effects of treatment for testicular cancer may take a long time to improve. Sometimes they can become permanent, or develop years after treatment.
What is chemotherapy?
Your doctor may suggest having chemotherapy treatment. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs travel around the bloodstream, destroying possible cancer cells anywhere in the body.
You may have chemotherapy:
- after surgery, to reduce the risk of testicular cancer coming back (adjuvant chemotherapy)
- to treat testicular cancer that has spread outside the testicle, or come back after an orchidectomy
- to treat testicular cancer that has come back after initial chemotherapy.
The drugs most commonly used to treat testicular cancer are:
- bleomycin
- etoposide
- cisplatin.
This combination is called BEP chemotherapy.
You may also have a chemotherapy drug called carboplatin.
We have more detailed information about chemotherapy.
Adjuvant chemotherapy
You may have adjuvant chemotherapy to reduce the risk of testicular cancer coming back.
- If you have an early (stage 1) non-seminoma, you may have 1 cycle of BEP. Each cycle is 3 weeks.
- If you have an early (stage 1) seminoma, you may have a single treatment with carboplatin.
Related pages
If the cancer has spread or comes back during monitoring (surveillance)
The chemotherapy drugs you have will depend on the stage of disease at diagnosis and previous cancer treatment. You may have 3 or 4 cycles of BEP if testicular cancer has:
- spread outside the testicle
- come back during monitoring (surveillance).
Sometimes, bleomycin is left out. You may have 3 or 4 cycles of etoposide and cisplatin (EP) instead. Your oncology doctor will explain which is the best chemotherapy combination for you and how many treatments you may have.
Bleomycin may cause breathing problems if you smoke or already have a lung condition.
Intensive chemotherapy
If BEP does not get rid of the cancer, or the cancer comes back, you will usually have more intensive chemotherapy. Depending on the stage of the cancer, you may have intensive chemotherapy straight away.
Some drug combinations are:
- PEI (cisplatin, etoposide, ifosfamide) – this drug combination is also sometimes called VIP
- TIP (paclitaxel, ifosfamide, cisplatin)
- VeIP (vinblastine, ifosfamide, cisplatin).
High-dose chemotherapy with stem cell support (autologous stem cell transplant)
Occasionally, high-dose chemotherapy with stem cell support may be used for testicular cancer. You may have this as part of a clinical trial.
Stem cells produce blood cells. The high-dose treatment destroys stem cells in the bone marrow, as well as the cancer cells. Because of this, doctors remove some stem cells before treatment. These are then stored to give back to you after treatment.
The stem cells are given back through a drip (infusion). This is called an autologous stem cell transplant. The cells go to your bone marrow and start to make blood cells again.
This type of treatment allows you to have higher than usual doses of chemotherapy. You usually have it if the cancer has not responded completely to previous treatment. Or you may have it if the cancer has come back after treatment. It is used to increase the chances of curing the cancer.
You may have high-dose treatment in hospitals with large cancer units that specialise in this type of treatment. This is an intensive treatment, and you will need to stay in hospital for several weeks.
How chemotherapy is given
You usually have chemotherapy as an outpatient. You have it as an injection or through a drip. This is called intravenous chemotherapy. You may have the drugs through a:
- cannula – a short, thin tube the nurse puts into a vein in your arm or hand
- central line – a fine tube that goes under the skin of your chest and into a vein close by
- PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest.
You have chemotherapy in cycles of treatment. A cycle usually takes 3 weeks.
If you are having BEP, you usually have to go to the hospital for 3 to 5 days as an outpatient. Sometimes you stay overnight. This is followed by weekly outpatient visits to have the rest of your cycle of treatment.
Other combinations of chemotherapy drugs might mean you spend more time in hospital and have the drugs more often. Your doctor or nurse will tell you more about your treatment options, how many cycles of treatment you need, and how you will have it.
Side effects of chemotherapy for testicular cancer
Chemotherapy drugs causes side effects. But there are usually ways these can be controlled. The side effects can depend on the type of chemotherapy drugs used. Your doctor or nurse will give you information about the likely side effects of your treatment.
We have more information about the side effects of chemotherapy.
Fertility and storing sperm before treatment
Your doctor will advise you to consider storing sperm (sperm banking) before having treatment. This is because chemotherapy for testicular cancer usually causes infertility during treatment and for a time after. This is usually temporary, and your fertility will usually recover after treatment. How quickly your sperm count recovers varies from person to person. It generally starts to recover about 18 to 24 months after treatment. But it can take up to 5 years to recover. If you have a low sperm count before chemotherapy treatment, sperm production can sometimes improve after treatment.
If you are having high-dose chemotherapy, you have a much higher risk of infertility. And infertility caused by this kind of treatment is usually permanent. If you are concerned about this, you can talk to a specialist.
Contraception
Although treatment may affect your fertility, it is not always possible to know when this will happen. You may still be able to get someone pregnant. Your doctor will advise you not to make someone pregnant during treatment. This is because the chemotherapy drugs can temporarily damage your sperm, and possibly harm a developing baby.
It is usually best to use a barrier method of contraception, such as a condom, while you are having treatment.
It is also important to continue using effective contraception for about a year after chemotherapy. This allows time for your sperm to recover from any damage that treatment may have caused. You can talk to your doctor or nurse about this.
About our information
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References
Below is a sample of the sources used in our testicular cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
The British Association of Urological Surgeons (BAUS) Guidelines on Testicular Cancer. March 2015. Available from: https://www.baus.org.uk/professionals/sections/testicular_cancer.aspx (accessed April 2022).
European Association of Urology (EAU) Guidelines on Testicular Cancer 2022. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Testicular-Cancer-2022.pdf (accessed April 2022).
European Society for Medical Oncology (ESMO). Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Last updated 2022.
European Society for Medical Oncology (ESMO). Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Last updated 2022. Available from: https://www.annalsofoncology.org/article/S0923-7534(22)00007-2/fulltext (accessed April 2022).
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This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.
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