Treatment for testicular cancer
After surgery to remove the testicle (orchidectomy), further treatment will depend on the stage and type of testicular cancer you have.
The three main treatments for testicular cancer are:
- surgery to remove a testicle (orchidectomy)
- chemotherapy to reduce the risk of the cancer coming back, or treat testicular cancer that has spread, or comes back after treatment
If testicular cancer has spread to the lymph nodes at the back of the tummy (abdomen), you may need surgery to remove the retroperitoneal lymph nodes.
After surgery to diagnose the cancer and remove the testicle your doctor will talk to you about surveillance. Surveillance is the option of monitoring you regularly in clinic. Or they may suggest you have further treatment.
Further treatment will depend on:
- the stage of the cancer and the risk of it coming back
- whether it is a non-seminoma or seminoma (see below).
Doctors also look at other factors such as, the size of the tumour and the levels of tumour markers, if present.
We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:
Stage 1 testicular cancer is cancer that has not spread outside the testicle. Surgery to remove the testicle (orchidectomy) may be the only treatment you need.
After orchidectomy, your doctor will talk to you about surveillance (monitoring) if the risk of the cancer coming back is low.
Your doctor may also offer you adjuvant chemotherapy treatment to reduce the risk of the cancer coming back.
Your doctor will explain why they have suggested adjuvant treatment. Your doctor and nurse will talk you through the benefits and disadvantages of each option and what might be best in your situation.
You may decide not to have treatment, and to have surveillance instead. You may want to avoid treatment that might not be necessary. Sometimes, if you have option of surveillance you may decide to have chemotherapy instead.
Talk about the treatments with your doctor. Make sure you have enough information to help you make your decision.
Seminoma stage 1
If you have a stage 1 seminoma, your doctor may suggest you have surveillance (monitoring). This is if there is a low risk of the cancer coming back. You usually need to have regular clinic appointments for several years.
They may also offer you a single dose of adjuvant chemotherapy, with a drug called carboplatin.
Your doctors decide if you will benefit from adjuvant treatment based on:
- the size of the tumour
- how it looks under a microscope
- the tumour marker levels (if present).
Non-seminoma stage 1
If you have a stage 1 non-seminoma, your doctor may suggest surveillance if there is a low risk of the cancer coming back. After a few years, if scans show no signs of the cancer coming back, you may only need regular blood tests.
They may also offer the option of adjuvant chemotherapy with bleomycin, etoposide and cisplatin (BEP). You may have 1 or 2 sessions. This will depend on:
- how the cancer looks under a microscope
- if it has spread to nearby blood vessels
- the size of the tumour
- the tumour marker levels (if present).
Rarely, your doctor may suggest further surgery to remove the lymph nodes at the back of the tummy (retroperitoneal lymph nodes).
Treatment can also depend on the stage of the cancer. Your doctors will talk to you about the treatment they think is best for you.
If you have a seminoma that has spread, your doctor may offer treatment with radiotherapy. Or they may offer you 3 or 4 courses of chemotherapy. Your doctor will talk with you about the treatment they think is best for you.
If you have a non-seminoma that has spread, you may need 3 or 4 sessions of chemotherapy. Or you may need more intensive chemotherapy. This will depend on the stage of cancer, certain risk factors and how you respond to standard chemotherapy.
If you have non-seminoma you may need surgery after chemotherapy to remove the retroperitoneal lymph nodes, if they are enlarged.
Treatments for testicular cancer can sometimes affect your ability to make someone pregnant (fertility). Doctors usually advise you to store your sperm (sperm banking) after, or sometimes before an orchidectomy.
Treatments do not affect your ability to have sex. But the emotional effects of your diagnosis and treatment side effects may reduce your sex drive for a while. There is different support available if you are having difficulties with your sex life.
We have more information about testicular cancer your sex life and fertility.
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 firstname.lastname@example.org
European Association of Urology. Guidelines on Cancer. 2016. Available from: www.baus.org.uk/_userfiles/pages/files/professionals/sections/oncology/EAU2015-Testicular-Cancer.pdf (accessed August 2018)
European Society for Medical Oncology, eUpdate. Testicular Seminoma and Non-Seminoma Treatment Recommendations. June 2017. Available from: www.esmo.org/Guidelines/Genitourinary-Cancers/Testicular-Seminoma-and-Non-Seminoma/eUpdate-Treatment-Recommendation (accessed August 2018).
Scottish Intercollegiate Guidelines Network, Management of adult testicular germ cell tumours. Available from: www.sign.ac.uk/sign-124-management-of-adult-testicular-germ-cell-tumours.html (accessed August 2018).
UpToDate. Clinical manifestations, diagnosis, and staging of testicular germ cell tumors. January 2018. Available from: www.uptodate.com/contents/clinical-manifestations-diagnosis-and-staging-of-testicular-germ-cell-tumors (accessed August 2018).
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 Jim Barber, Consultant Clinical Oncologist.
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