Treatment for testicular cancer

If you had an orchidectomy and the cancer was completely removed, you may not need any further treatment. Instead, you will have surveillance, with regular blood tests (checking tumour markers) and CT scans for 5–10 years.

Surveillance can help find if there is any cancer remaining (residual cancer). It can also help work out if the cancer has come back (recurrence). How often you will need check‑ups and tests will depend on whether you had seminoma or non‑seminoma testicular cancer. Your doctor will tailor a surveillance schedule for your situation.

It’s important to follow the surveillance schedule outlined by your doctor. While it may be tempting to skip appointments if you are feeling better or if you were diagnosed with stage 1 cancer, surveillance can help to find cancer early if it comes back.

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells or slow their growth, while causing the least possible damage to healthy cells.

When chemotherapy is given after surgery, it is known as adjuvant treatment. If the cancer is only in the testicle, it can usually be treated with surgery alone and chemotherapy may not be needed. Sometimes, however, your treatment team assesses that there is a moderate risk of the cancer spreading or returning. In this case, a single dose (or two cycles) of chemotherapy will be recommended. After treatment, you will be monitored through surveillance with follow-up appointments and tests for 5 –10 years.

In rare cases, when the cancer has spread to other parts of the body, chemotherapy may be given before surgery as the primary treatment.

There are many types of chemotherapy drugs. Some people are given a drug called carboplatin, which is often used for early stage seminoma cancer after surgery. Other drugs commonly used for testicular cancer are bleomycin, etoposide and cisplatin. When these three drugs are used together, it is called BEP chemotherapy.

Chemotherapy is usually put into a vein (intravenously) through a drip. Bleomycin may also be given by injection into a muscle (intramuscularly). In either case, chemotherapy is given in cycles, which means you will receive the drugs for a period of time and then have a rest period of a few weeks before starting a new cycle.

The number of treatment cycles you have will depend on the type and stage of the cancer. Your doctor will give you more information. You will probably have to visit the hospital as an outpatient each time you have chemotherapy.

Side effects of chemotherapy

Chemotherapy drugs damage cells as they divide. This makes the drugs effective against cancer cells, which divide more rapidly than most normal cells do. However, some normal cells – such as hair follicles, blood cells, and cells inside the mouth or bowel – also divide rapidly. Side effects can occur when chemotherapy damages these normal cells.

Everyone reacts differently to chemotherapy. Some people don’t experience any side effects, while others have a few. Side effects are usually temporary, and there are medicines that can help reduce your discomfort. Talk to your doctor or nurse about any side effects you have and ways to manage them.

Fatigue – Most people feel tired during chemotherapy, particularly as treatment progresses.

Low white blood cell count – About a week after a treatment session, your white blood cell levels may drop, making you more prone to infections. If you feel unwell or have a fever higher than 38°C, call your doctor immediately or go to the nearest hospital emergency department.

Nausea and vomiting – It is common to feel ill or vomit within a few hours of chemotherapy treatment. Anti-nausea medicines can prevent or at least reduce this feeling. In most cases, an anti-nausea medicine will be injected at the same time as the chemotherapy is given. You may be given other anti-nausea medicines to take home in case nausea occurs. These are available in many forms, including tablets that you swallow, wafers that dissolve on the tongue and suppositories to put into your bottom (rectum). Tell your medical team if you still feel sick as you may be able to try a different form of medicine.

Constipation – Sometimes chemotherapy drugs can affect the nerve endings in the bowel, making it hard to pass a bowel motion and causing constipation. More often, constipation occurs as a side effect of the anti-nausea medicines. Your medical team can prescribe medicines to help with constipation.

Hair loss – Chemotherapy often causes hair loss from the head and body, but hair usually grows back once treatment is over.

Erection problems – Chemotherapy can affect erections, but this is usually temporary. You may also find you have a lower sex drive (libido).

Lower sperm production – The chemotherapy drugs may reduce the number of sperm you produce and their ability to move (motility). This can cause temporary or permanent infertility. Speak with your doctor about sperm banking before starting chemotherapy. You will still need to use contraception to protect your partner from any drugs in your semen and to avoid pregnancy.

Peripheral neuropathy – Some drugs affect the nerves, causing numb or tingling fingers or toes. This is called peripheral neuropathy. It usually improves after treatment is finished.

Ringing in the ears – Some types of chemotherapy drugs can cause short-term ringing or buzzing in the ears. This is known as tinnitus.

Breathlessness, cough or unexplained symptoms – Some drugs can damage the lungs or kidneys. You may have lung and kidney function tests to check the effects of the drugs on your organs.

Risk of heart disease – Having chemotherapy for testicular cancer increases the risk of developing heart (cardiovascular) disease. You will have tests to check your heart function before and after treatment.

Risk of other cancers – People who have chemotherapy for testicular cancer are at a slightly higher risk of developing leukaemia, which is a blood cancer. This outcome is extremely rare, so the benefit of receiving treatment outweighs this risk. However, you will have regular check-ups after treatment to test for cancer.

Using contraception during treatment

Even if treatment lowers sperm production, there is still a chance your partner could become pregnant. Because chemotherapy and radiation therapy can damage sperm, you will need to use contraception during treatment and sometimes for some months afterwards to prevent pregnancy. Your doctor will discuss this with you in more detail.

Download our booklet ‘Understanding Chemotherapy’

Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. The radiation is usually in the form of focused, high-energy x-ray beams.

Radiation therapy is sometimes given to people with seminoma cancer after surgery to prevent the cancer from coming back and to destroy any cancer cells that may have already spread from the cancer to the lymph glands.

Treatment is carefully planned to ensure that any remaining cancer cells are destroyed while causing the least possible harm to normal tissue. During a radiation therapy session, you will lie under a machine called a linear accelerator. The radiation is directed at lymph glands in the back of the abdomen or in the pelvis. The unaffected testicle may be covered with a lead barrier to help preserve your fertility.

Radiation therapy is painless and can’t be felt. It is just like having an x-ray taken. The treatment itself takes only a few minutes, but each session may last 10–15 minutes because of the time it takes to set up the equipment and place you in the correct position.

Most people have outpatient treatment sessions at a radiation therapy centre from Monday to Friday for 2–4 weeks. Your doctor will let you know how many sessions you need.

Side effects of radiation therapy

Radiation therapy can cause a range of side effects, including skin reactions, fatigue and stomach problems. Most side effects disappear within a few weeks of finishing treatment.

Skin reactions – In most cases, radiation therapy for testicular cancer won’t irritate the skin in the treatment area. If the skin does become red or sore, talk to your treatment team about using a moisturising cream, such as sorbolene.

Fatigue – Some people find they become very tired and lack energy for everyday tasks. Try doing some gentle exercise as this can help with fatigue. Plan your activities so you can rest regularly during the day. Talk to your family and friends about how they can help you. The tiredness often lasts for a few weeks after treatment is finished.

Stomach problems – If the treatment area includes your abdomen, you could have some minor stomach-aches, nausea or bloating. Your doctor may prescribe medicines to prevent these symptoms from occurring, or to treat them if they do occur.

Bowel problems – Radiation therapy sometimes causes diarrhoea and cramping. These bowel irritations are usually minor and do not need treatment, but if they are bothering you, talk to your doctor about adjusting your diet or taking medicines.

Hair loss – You may lose pubic and abdominal hair in the treatment area. After treatment, your hair will usually grow back.

Bladder irritation – In some people, the bladder and urinary tract may become irritated and inflamed. Drinking plenty of fluids will help, but you should avoid alcoholic or caffeinated beverages, as they can irritate the bladder further.

Infertility – Radiation therapy may reduce sperm production or damage sperm. The effect on sperm may be temporary or permanent. Speak with your radiation oncologist about sperm banking before starting radiation therapy. You will still need to use contraception.

Risk of heart disease – People who have radiation therapy for testicular cancer have a higher risk of heart (cardiovascular) disease. You will have heart function tests before and after treatment.

Risk of other cancers – People who have radiation therapy for testicular cancer are at a slightly increased risk of a secondary cancer in the area exposed to radiation. If these cancers do occur, they appear many years after treatment. Because of this small risk, you will have regular check-ups after radiation therapy to test for cancer.

Your radiation oncologist will see you at least once a week to monitor and treat any side effects during the course of your treatment. You can also talk to a nurse if you are concerned about side effects.

Using contraception during treatment

Even if treatment lowers sperm production, there is still a chance your partner could become pregnant. Because chemotherapy and radiation therapy can damage sperm, you will need to use contraception during treatment and sometimes for some months afterwards to prevent pregnancy. Your doctor will discuss this with you in more detail.

Download our booklet ‘Understanding Radiation Therapy’

In some cases, an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) is done to remove lymph nodes at the back of the abdomen that may contain cancer cells.

Non-seminoma cancer – Your doctors may recommend an RPLND if scans after chemotherapy show that the lymph nodes have not returned to normal size, as this may mean that they still contain cancer cells.

Seminoma cancer – Chemotherapy or radiation therapy can usually destroy seminoma cancer cells in the lymph nodes, so an RPLND is rarely used. However, it may be offered for advanced seminoma cancer if there are no other treatment options.

An RPLND is a long, complex operation and should be performed by a surgeon with a lot of experience in the procedure. The standard approach involves open surgery, with a large cut made from the breastbone to below the bellybutton. The surgeon moves the organs out of the way, then removes the affected lymph nodes from the back of the abdomen (the retroperitoneum). Your surgeon can give you more information about this operation.

Side effects of RPLND

It can take many weeks to recover from an RPLND – at first, you will probably be very tired and may not be able to do as much as you are used to. The main side effects are pain and tenderness in the abdomen. Tell your doctor or nurses if you are in pain, as they can prescribe medicines to make you more comfortable.

An RPLND may also damage the nerves that control ejaculation. This can cause retrograde ejaculation, which is when semen travels backwards into the bladder, rather than forwards out of the penis. Your surgeon may be able to use a technique called nerve-sparing surgery that avoids damaging these nerves, but this is not always possible.

Although retrograde ejaculation is not harmful, it causes infertility. If having children is important to you, you can store some sperm before an RPLND. Talk to your surgeon for more information.

Download our booklet ‘Fertility and Cancer’

In the rare situation that testicular cancer is so advanced that treatment cannot make it go away, your doctor may talk to you about palliative treatment.

Palliative treatment helps to improve people’s quality of life by managing symptoms of cancer without trying to cure the disease. Many people think that palliative treatment is only for people at the end of their life, but it can help people at any stage of advanced cancer. It is about living for as long as possible in the most satisfying way you can.

As well as slowing the spread of the cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment options may include radiation therapy, chemotherapy or other medicines.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, practical, emotional, spiritual and social needs. The team also supports families and carers.

Download our booklet ‘Understanding Palliative Care’

Download our booklet ‘Living with Advanced Cancer’