Testicular Cancer: Treatments

Treatment options for this type of cancer include surgery, radiation and chemotherapy.

Surgery

Surgery is often the only treatment needed for early testicular cancer. The following operation is used not just to diagnose but to treat the cancer, for it removes the primary site of the malignant cells.

Inguinal orchiectomy (also called a radical orchiectomy). During this procedure, a highly skilled surgeon removes the testicle and the sperm chord through an incision in the groin (or “inguinal region”). Often this operation is performed as same-day surgery with the patient returning home a few hours later. To maintain a natural appearance, a patient may decide to have a prosthetic testicle inserted, which may increase operating time.
While it’s possible to remove a testicle directly through the scrotum, this is not done when cancer is suspected, because it interrupts the drainage of the lymphatic system—the site where cancer tends to spread—and may also make further surgeries more difficult.
A tissue sample from the testicle is examined under a microscope for the presence of cancer cells.

Losing a testicle usually has no effect on a man’s ability to have an erection, perform sexually, or father children. If both testicles are removed, however, the body can no longer produce sperm cells and a man becomes infertile. However, it is possible to freeze sperm cells for younger men who wish to have children at some point in the future. Normal sexual function is preserved by regular administration of testosterone by injection.

Men who have testicular cancer often have lower sperm counts which can make it hard to collect a good sperm sample. Urology partners with male fertility specialists to assist patients who are concerned about having children.

Retroperitoneal lymph node dissection (RPLND) may be performed at the same time at orchiectomy. In this procedure, the surgeon removes the abdominal lymph nodes to check for the spread of testicular cancer to the lymphatic system. This operation is used both to treat testicular as well as help establish its exact stage and type.

An incision is made extending from the breastbone to a point several inches below the navel. A tissue sample is then taken from the area and examined underneath a microscope to determine the extent of spread of the disease. If no malignant tissue is found, the cancer is considered as a stage I cancer, limited to the testicles.

This surgery can be performed using a minimally invasive method that requires a smaller incision and results in less recovery time.

This type of surgery does not interfere with a man’s ability to get an erection. However, it may affect the nerves that control ejaculation. A special nerve-sparing technique has been developed to preserve this aspect of male sexual function.

Radiation Therapy

Radiation therapy is used only for patients with seminoma. Compared to other cancers, lower doses of radiation are used to treat testicular cancer. 

External Beam Radiation Therapy (EBRT) is the most common approach. This treatment is generally prescribed for patients with seminomas and does not appear to be effective with nonseminomas. The procedure is painless and the treatment is very much like getting an x-ray only the radiation is more intense. The radiology team takes precise measurements to target only the affected area, and to determine the exact dose of radiation. While the treatment itself takes on a few minutes, the setup time is usually longer.

Radiation therapy is often given after orchiectomy (surgery to remove the testicle). At that point, radiation is directed at the lymph nodes in the back of the abdomen to destroy any cancer that doesn’t show up in imaging tests, or to treat small amounts of seminoma that have spread to the nodes and can be detected by CT and PET scans.

During radiation treatment, a shield is employed to keep radiation from reaching the healthy testicle and to prevent infertility.

For more information about radiation therapy, please visit the Department of Radiation Oncology.

Chemotherapy

Chemotherapy is used to cure testicular cancer that has spread beyond the testicles or to keep it from recurring, after a testicle has been surgically removed.

Chemotherapy is a form of systemic therapy, meaning that the drug travels throughout the body to attack the cancer cells. While chemotherapy may be injected into a vein or muscle, or given in pill form (by mouth), drugs for testicular cancer are generally given intravenously.

Chemotherapy is prescribed in cycles, with each treatment followed by a rest period, generally over a time frame of three to four weeks. Commonly cisplatin, etoposide, and bleomycin are used over a 9-week course for effective treatment of testis cancer that has spread.