Surgery for testicular cancer
Most men with testicular cancer will have surgery. The type of surgery you have depends mainly on the stage of the cancer and how it responds to treatment. When planning surgery, your healthcare team will also consider other factors, such as your serum tumour marker levels and your wish to have children.
Surgery may be done for different reasons. You may have surgery to:
- diagnose and help stage testicular cancer
- completely remove the tumour
- remove tumours that have spread to other parts of the body, such as the lungs
- remove any cancer that remains after radical inguinal orchiectomy and chemotherapy (called residual disease)
The following are the types of surgery most commonly used to treat testicular cancer. You may also have other treatments before or after surgery.
Radical inguinal orchiectomy
Radical inguinal orchiectomy is the first treatment for any stage of testicular cancer and it is usually done as part of diagnosis. In some cases, chemotherapy may be given before this surgery is done.
While you are under general anesthesia (you will be unconscious) or spinal (epidural) anesthesia, the surgeon makes a small cut in the groin. The surgeon removes the testicle and spermatic cord from the scrotum through the opening in the groin. The testicle isn’t removed through the scrotum (called transscrotal orchiectomy) because there is a risk that doing so could spread cancer cells into the lymph vessels. Both testicles may be removed (called bilateral orchiectomy) if doctors believe both testicles have cancer in them. The surgery takes about 30 minutes and you can usually go home the same day.
A testicular prosthesis, or artificial testicle, can be placed in the scrotum after an orchiectomy. The prosthesis may be placed at the same time as surgery to remove the testicle, or it can be placed during another surgery done later. Talk to your healthcare team about getting a testicular prosthesis and the best time to place the prosthesis.
Retroperitoneal lymph node dissection
Retroperitoneal lymph node dissection (RPLND) may be done for stage 1 and 2 non-seminomas or for any type of testicular cancer that doesn’t respond to chemotherapy.
While you are under general anesthesia, the surgeon makes a large cut in the middle of the abdomen. The surgeon removes lymph nodes from the back of the abdomen (called the retroperitoneum). If the surgeon removes lymph nodes from the same side of the body as the tumour, it is called ipsilateral RPLND. If the surgeon removes lymph nodes from both sides of the body, it is called bilateral RPLND. The surgery takes several hours to complete.
RPLND may be done at the same time as an orchiectomy, or it can be done later during another surgery.
Sometimes testicular cancer doesn’t completely respond to chemotherapy that is given after an orchiectomy. The cancer that remains after these primary treatments is called residual disease. Surgery used to remove residual disease is called salvage surgery. If there are high levels of tumour markers in the blood, some men may have salvage surgery to remove residual disease.
Salvage surgery may include a bilateral RPLND if it wasn’t done during a previous surgery.
Surgery for metastases
Surgery may also be used to remove testicular cancer that has spread, or metastasized, to the lung, mediastinum, brain, liver or neck.
Questions to ask about surgery
The space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes.