How is Testicular Cancer Treated

Types of treatment

Treatment for testicular cancer is usually very successful and most men can now be completely cured, even if the cancer has spread beyond the testicles. The treatment will depend on the type of cancer (whether it is a teratoma or a seminoma) and whether it has spread beyond the testes.

There are three main types of treatment:

• Surgery
• Radiotherapy
• Chemotherapy

Surgery

Surgical removal of the testicle (orchidectomy) is usually the first treatment for both seminoma and teratoma. It also enables your doctor to make an exact diagnosis. But remember, no operation or procedure will be carried out without your written consent.

It is uncommon for cancer to affect both testicles. A very small proportion of men develop a new cancer in the remaining testicle. For this reason a small biopsy of the unaffected testicle may be suggested at the time of the initial orchidectomy or during follow-up. This is a procedure in which a thin needle is passed through the skin of the scrotum to take a small sample of cells from the testicle. If no signs of early cancer are present this is very reassuring. If the earliest stage of cancer is present (carcinoma in situ) this can be cured by a low dose of radiotherapy.

Further surgery is sometimes needed after radiotherapy or chemotherapy, to remove any cancer cells that may still be in the lymph glands of the abdomen or chest.  

Further treatment

If the cancer has not spread and was completely removed with the testicle, the operation may be the only treatment you will need.

Surveillance

After your operation, it is very important for you to be seen regularly in the outpatient’s clinic by your doctor for blood tests, chest x-rays and CT scans. This is because in some patients the cancer may come back in the glands at the back of the abdomen or in the lungs. If your doctor feels that the risk of the cancer returning is very low, you will be seen regularly in the clinic and will not have any further treatment unless your tests show that the cancer has come back. This is known as a surveillance policy. In the small proportion of men in whom the cancer does come back, the regular tests will detect the cancer when it is still very small and further treatment can give an excellent chance of cure.

If the risk of the cancer returning is thought to be higher, it may be necessary to give further treatment to prevent this happening. This is known as adjuvant therapy and the type of treatment will depend on the type of cancer:

Teratoma

Teratoma is very sensitive to chemotherapy. If the teratoma seemed to be contained within the testicle, two courses of chemotherapy may be given following orchidectomy, to reduce the chance of recurrence. Three or four courses of chemotherapy may be given if the teratoma has spread beyond the testicle, or if it comes back after orchidectomy.

Seminoma

Even if the seminoma has not spread, men may be offered surgery, followed by radiotherapy to the glands at the back of the abdomen, to reduce the chance of recurrence. A single dose of chemotherapy is being tried as an alternative to this treatment. Radiotherapy will be given if the seminoma has spread to the lymph glands at the back of the abdomen. If the lymph glands are large or if the seminoma has spread beyond the lymph glands (this is rare) you would also be treated with 3 or 4 courses of chemotherapy.

Radiotherapy

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to the normal cells. It is often used to treat seminoma but not usually to treat teratoma.

• Planning your treatment
• Side effects
• When is it given? 

Planning your treatment

To ensure that you receive maximum benefit from your radiotherapy it has to be carefully planned. On your first few visits to the radiotherapy department you will be asked to lie under a large machine called a simulator which takes x-rays of the area to be treated.

Treatment planning is a very important part of radiotherapy and it may take several visits before the radiotherapist (the doctor who plans your treatment) is satisfied with the result.

Marks will be drawn on your skin to help the radiographer (who gives you your treatment) to position you accurately and to show the exact place for the rays to be directed. At the beginning of your treatment you will be given instructions on how to look after the skin in the area being treated. You will be told whether you can wash the marked areas of skin. Do not rub the area, as this may make it sore. Perfumed soaps, talcs, deodorants and lotions may also make your skin sore and should not be used.

Before radiotherapy is given, the radiographer will position you carefully on the couch and make sure you are comfortable. During your treatment, which only takes a few minutes, you will be left alone in the room but you will be able to talk to the radiographer who will be watching you carefully from an adjoining room. Radiotherapy is not painful but you do have to lie still for a few minutes while your treatment is given.

Radiotherapy side effects

Radiotherapy to the abdomen can cause side effects such as feelings of sickness (nausea), tiredness, and diarrhoea. Most of these side effects are mild and can be treated successfully with drugs. Anti-sickness tablets (anti-emetics) will usually be given to you at the start of radiotherapy. It is important to let your doctor know if you are having any problems. Any side effects should gradually disappear once your course of treatment is over.

While you are having radiotherapy it is important to drink plenty of fluids and have a healthy diet. If you don't feel like eating you could try supplementing your meals with high calorie drinks, which are available at most chemists (some are also available on prescription). During your treatment you should try to get as much rest as you can, especially if you have to travel a long way each day for treatment.

Radiotherapy does not make you radioactive and it is perfectly safe for you to be with other people, including children, throughout your treatment.

When is it given

Radiotherapy is given to men with seminoma either to prevent the cancer coming back after surgery or to treat disease that has spread to the glands at the back of the abdomen. It is a highly successful treatment, which will cure almost all men with this type of cancer.

The treatment is given in the hospital radiotherapy department usually as daily sessions from Monday to Friday, with a rest at the weekend. The length of your treatment will be decided by your doctor, but the whole course normally lasts from two to four weeks.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells and as they circulate in the blood, they can reach cancer cells all over the body. The drugs most commonly used to treat testicular cancer are cisplatin, etoposide and bleomycin.

Chemotherapy may be given to men with teratoma, either to prevent the cancer coming back after surgery or to treat any cancer that has spread to the glands at the back of the abdomen, or elsewhere in the body. Men with seminoma usually have chemotherapy if there are a lot of cancer cells in the glands at the back of the abdomen, or if the seminoma has spread beyond the lymph glands.

Chemotherapy using a single dose of just one drug is also being tried to treat seminoma if the cancer does not seem to have spread. This is an alternative to radiotherapy to the glands at the back of the abdomen. Chemotherapy may also occasionally be used to shrink down a large testicular cancer before surgery so that it can be removed more easily.

The chemotherapy drugs are given by injection into a vein (intravenously). Chemotherapy is given as several courses of treatment which may last from two to five days, depending on the type of chemotherapy, followed by a rest period of a few weeks, which allows your body to recover from any side effects of the treatment. Chemotherapy for testicular cancer will usually mean spending a few days in hospital every three weeks from two to four times. If the cancer has spread to other parts of the body four to six courses of chemotherapy may be necessary, or the treatment may be given weekly.

Treatment for testicular cancer is very successful, and the cancer does not usually come back after standard chemotherapy treatment.

High dose chemotherapy with stem cell support

High dose chemotherapy may be used if the standard chemotherapy does not completely get rid of the cancer cells (which is rare) or if the cancer is very advanced when it is found and there is a high risk that standard chemotherapy will not destroy all of the cancer cells.

This treatment involves giving very high doses of chemotherapy to try to destroy all the testicular cancer cells. As these high doses also damage cells in the bone marrow, certain cells in your blood called peripheral blood stem cells are collected and stored before treatment begins, then returned to the blood afterwards.

Chemotherapy side effects

While the chemotherapy drugs are acting on the cancer cells in your body they may also temporarily reduce the number of normal cells in your blood. When these cells are in short supply, you are more likely to get an infection and to tire easily. It is important to let your GP or cancer specialist know straight away if you feel unwell or develop a temperature at any time during your treatment. During chemotherapy your blood will be tested regularly and, if necessary, you will be given antibiotics to treat any infection. If the number of white blood cells drops below a certain level you may be given a drug known as a haematopoietic growth factor (GCSF) to stimulate the bone marrow.

Chemotherapy can cause changes in kidney function and your doctors will take regular blood tests to see how well your kidneys are working.

Other common side effects of chemotherapy include:

• Nausea and vomiting. This can be helped by taking anti-sickness drugs (anti-emetics) which your doctor can prescribe.
• Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and the nurse will show you how to use these properly.
• Loss of hunger, if you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.
• Hair loss is another common side effect. People who lose their hair often wear wigs, hats or scarves. You may be entitled to a free wig from the National Health Service. A doctor or the nurse looking after you will be able to arrange for a wig specialist to visit you. Your hair will grow back within 3-6 months.
• One of the drugs (bleomycin) can occasionally cause inflammation in the lungs and this can lead to shortness of breath. This is usually mild, but if it becomes a problem your doctor may stop or change the drug.
•  Another drug (cisplatin) can cause tinnitus (ringing in the ears) and you may lose the ability to hear some high pitched sounds. This usually decreases when the treatment ends. You may also notice numbness or tingling in your hands and feet or difficulty doing up buttons. Your hands and feet may also become more sensitive to the cold. This is due to the effect of the drug on the nerves.

Although they may be hard to bear at the time, these side effects will usually disappear once your treatment is over.

Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.