Testicular cancer

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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 health and specific information about the cancer. When deciding which treatments to offer for testicular cancer, your healthcare team will consider:

  • the type of germ cell tumour (seminoma or non-seminoma)
  • the stage of the cancer
  • the risk of cancer coming back (recurrence)
  • if you want to be able to get someone pregnant (fertility)
  • what you prefer or want

You may be offered one of the following treatments or a combination of the treatments for testicular cancer.

Surgery

The following types of surgery can be used to treat testicular cancer.

Radical inguinal orchiectomy (an orchiectomy) removes the testicle and spermatic cord. It is usually the first treatment for testicular cancer and it is done to remove the cancerous testicle and confirm the diagnosis.

Retroperitoneal lymph node dissection (RPLND) is surgery to remove lymph nodes at the back of the abdomen (the retroperitoneum). If the lymph nodes on the same side of the body as the tumour are removed, it is called an ipsilateral RPLND. If the lymph nodes on both sides of the retroperitoneum are removed, it is called a bilateral RPLND. This surgery may be done at the same time as the orchiectomy or as another surgery done later. An RPLND can be part of the treatment for early stages of testicular cancer. It can also be used to treat advanced testicular cancer after chemotherapy.

Postchemotherapy surgery removes cancer that remains after an orchiectomy and chemotherapy. It may be done when testicular cancer doesn’t completely respond to chemotherapy that is given after an orchiectomy. Postchemotherapy surgery may include a bilateral RPLND.

Surgery for metastases may be used to remove testicular cancer that has spread (metastasized) to the lungs, mediastinum, liver, brain or neck.

Chemotherapy

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. 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 (recurs). 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 an autologous peripheral blood stem cell transplant).

Radiation therapy

Radiation therapy may be used to treat stage 1 or 2 seminomas after an orchiectomy. It is given as external radiation therapy (also called external beam radiation therapy). Radiation is directed at the lymph nodes in the abdomen and pelvis.

Active surveillance

Active surveillance is the preferred treatment for stage 1 testicular cancer after an orchiectomy. During active surveillance, the healthcare team watches for any signs and symptoms that mean the cancer has come back. Treatment is only given when the cancer comes back.

Fertility problems

Some treatments for testicular cancer can cause fertility problems, which can affect a man’s ability to produce children (get someone pregnant). Talk to your doctor if you want to have children in the future. They may suggest sperm storing or banking before starting cancer treatment.

Find out more about supportive care for testicular cancer, including fertility problems.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Follow-up care

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.

Clinical trials

Talk to your doctor about clinical trials open to men with testicular cancer in Canada. Clinical trials look at new 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.

mediastinum

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.

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