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Treatments for testicular cancer
If you have testicular cancer, your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for testicular cancer, your healthcare team will consider:
- the type of germ cell tumour (if it is a seminoma or non-seminoma)
- the stage of the cancer
- the risk of recurrence
- your wish to have children (fertility)
- your personal preferences
You may be offered the following treatments for testicular cancer.
The following types of surgery can be used to treat testicular cancer.
Radical inguinal orchiectomy removes the testicle and spermatic cord. It is usually the first treatment for testicular cancer, and it is done to confirm the diagnosis.
Retroperitoneal lymph node dissection (RPLND) is surgery to remove lymph nodes at the back of the abdomen (which is called the retroperitoneum). If the lymph nodes on the same side of the body as the tumour are removed, it is called ipsilateral RPLND. If the lymph nodes on both sides of the retroperitoneum are removed, it is called bilateral RPLND. This surgery may be done at the same time as the radical inguinal orchiectomy or as another surgery done later. RPLND can be part of treatment for early stages of testicular cancer. It can also be used to treat advanced testicular cancer after chemotherapy.
Salvage surgery removes cancer that remains after orchiectomy and chemotherapy. It may be done when testicular cancer doesn’t completely respond to chemotherapy that is given after an orchiectomy. Salvage surgery may include a bilateral RPLND.
Surgery for metastases may be used to remove testicular cancer that has spread, or metastasized, to the lung, mediastinummediastinumThe space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes., liver, brain or neck.
Chemotherapy is a common treatment for all stages of testicular cancer. It is usually given after an orchiectomy. A combination of chemotherapy drugs is usually given.
BEP is the main chemotherapy combination used for testicular cancer. It includes bleomycin (Blenoxane), etoposide (Vepesid, VP-16) and cisplatin (Platinol AQ). Sometimes doctors just give etoposide and cisplatin (called EP). EP is given when bleomycin affects the lungs (called pulmonary toxicity), or there is a high risk that it will cause lung damage.
High-dose chemotherapy and stem cell transplant may be used for recurrent testicular cancer if standard-dose chemotherapy doesn’t work and the cancer comes back. High doses of carboplatin (Paraplatin, Paraplatin AQ) and etoposide are given. After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that are damaged or destroyed by high-dose chemotherapy. The stem cell transplant uses stem cells from your own blood (called autologous peripheral blood stem cell transplant).
Radiation therapy may be used to treat stage I or II seminomas after orchiectomy. It is given as external beam radiation therapy. Radiation is directed at the lymph nodes in the abdomen and pelvis.
Active surveillance is the preferred treatment for stage I testicular cancer after a radical inguinal orchiectomy. During active surveillance, the healthcare team watches for any signs and symptoms that mean the cancer has come back, or recurred. Treatment is given only if testicular cancer recurs.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 10 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to men with testicular cancer. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.