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Testicular Cancer

How Is Testicular Cancer Treated?

Wednesday, April 25, 2012 - 15:17

Contributing Author: Guy Slowik FRCS

No one treatment works for all testicular cancer. This is because the two basic types of testicular cancer-seminomas and nonseminomas-differ in:

  • Their tendency to spread
  • The way they spread
  • How they respond to radiation therapy

Because of these different characteristics, seminomas and nonseminomas require different treatments. The treatment combinations are chosen depending on the tumor type and the stage of the disease.

Once the stage of testicular cancer has been determined, the cancer can be treated in several different ways:

Surgery

When testicular cancer is suspected, the affected testicle is removed and examined under a microscope. This procedure is called aninguinal orchiectomy (surgical removal of the testicle), and it involves removing the testicle from the scrotum.

Presurgical preparations include:

  • The patient is instructed to have nothing to eat or drink after midnight the night before the procedure.
  • Sometimes (depending on the doctor and/or the insurance) the patient is admitted to the hospital the day or night before the procedure; on other occasions, the patient is admitted the day of the surgery.

The operation is performed either with general anesthesia (in which the patient is asleep) or local anesthesia (in which the area of surgery is numbed, and the patient is sedated but awake).

  • An incision is made in the groin and the testicle is "delivered" from the scrotal sac up into the groin incision. This is to avoid an incision through the scrotum to the cancerous testicle, which may lead to spreading of the cancer.
  • The testicle is "delivered" after the spermatic cord (which connects the testicle to structures within the abdomen) has been clamped. Once delivered, the testicle with its cord clamped can be more safely handled without spreading the cancer.
  • The entire suspected testicle is removed because if the problem is cancer, cutting through the outer layer of the testicle to obtain a tissue sample might cause spreading of the disease.
  • After removal of the testicle, the incision is closed with stitches.

After surgery:

  • Complete healing can be expected without complications.
  • The patient is advised to wear an athletic supporter and to avoid vigorous exercise for a month or so after the operation.

Need To Know:

Removal of one testicle does not affect sex drive, potency (the ability to have an erection), or the ability to father children.

Radiation Therapy

Radiation therapy (also called radiotherapy, cobalt treatment, or irradiation) uses high-energy x-rays to treat cancer. Like surgery, radiation therapy is a local treatment, only affecting cells in the treated area.

For further information about radiation therapy, go to Radiation Therapy.

Chemotherapy

Chemotherapy is the use of specialized drugs to treat cancer. Chemotherapy is used when:

  • There are signs that the cancer has spread
  • The doctor suspects that cancer remains after surgery or radiation

The drugs used for treatment are usually a combination of cisplatin andetoposide, two drugs that control the disease with minimal side effects.

Other drugs approved for use with testicular cancer include:

  • Ifosamide (Ifex)
  • Vinblastine sulfate (Velban)
  • Bleomycin sulfate (Blenoxane)

Treatment For Seminomas

Seminomas are generally slow growing, with a tendency to stay localized-that is, in the testicle-so it is not usually necessary to remove lymph nodes.

Seminomas are especially susceptible to radiation, which effectively destroys any cancer cells that might be in the retroperitoneal lymph nodes.

When seminomas are diagnosed in Stage 1 or 2, treatment is usually a combination of:

  • Testicle removal
  • Radiation
  • Chemotherapy

When seminomas are diagnosed in Stage 3, treatment is usually chemotherapy.

Treatment For Nonseminomas

Most nonseminomas are diagnosed in the later stages. Even so, when confined to the testicle, this type of cancer is usually treated with:

  • Testicle removal
  • Careful follow-up for at least two years

About 10% of Stage 1 nonseminomas recur (come back again). If this happens, treatment includes chemotherapy.

When nonseminoma cancer is diagnosed in Stage 2, and patients have had testicle and lymph node removal, they may need no further therapy. However, some specialists recommend a short course of chemotherapy to reduce the risk of recurrence.

Stage 3 nonseminomas is usually treated with chemotherapy.

Testicular Cancer