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  • Treatment for testicular cancer

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    In almost all cases an orchidectomy is done to remove the affected testicle. Additional treatments for testicular cancer may include chemotherapy, radiotherapy or a combination of treatments to kill any remaining cancer cells or prevent the cancer from coming back. 

    Your medical team will advise you on the best treatment for you.

    They will consider:

    • your general health
    • the type of testicular cancer you have
    • the size of the tumour
    • the number and size of any lymph nodes involved
    • whether the cancer has spread to other parts of your body. If testicular cancer does spread, it most commonly spreads to the lymph nodes in the pelvic and lower abdominal regions.

    Sperm banking

    Chemotherapy, radiotherapy and surgery can cause temporary or permanent infertility. If you would like to have children in the future ask your doctor for a referral to a fertility specialist before treatment starts, as you may be able to store sperm for later use.

    For more information about sperm banking call Cancer Council 13 11 20 for a free copy of Cancer Council’s Fertility and Cancer booklet.

    Surgery

    Surgery to remove the testicle (orchidectomy)

    An orchidectomy is the main treatment for testicular cancer when it has not spread.

    You will be given a general anaesthetic before the operation.

    The surgeon will make a cut (incision) in the groin above the pubic bone. The testicle is then pulled up and out of the scrotum through the cut. The spermatic cord is also removed because it contains blood and lymph vessels that may act as a pathway for the testicular cancer to spread to other areas of the body.

    The surgery usually takes about an hour however you may have to stay a day or more in hospital to recover. You will have a few stitches above the pubic bone in your groin.

    Tissue that is removed during surgery is sent to a specialist called a pathologist who examines the cells under a microscope and provides information about the cancer.

    Most men have only one testicle removed. It is rare for both testicles to be affected by cancer at the same time.

    Occasionally men with testicular cancer need further surgery. This may be to remove the lymph nodes at the back of the abdomen (retroperitoneal lymph node dissection).

    Recovery after surgery

    Side effects of surgery

    You may experience some of the following side effects after surgery.

    Pain – your doctor can prescribe you medication to control any pain you have after the operation. Let the doctor or nurses know if the pain worsens – don’t wait until it is severe before asking for more pain relief.

    Bruising – you may have some bruising around the wound and scrotum. Blood may collect inside the scrotum (intrascrotal haematoma). If this occurs the swelling may make it feel like the testicle hasn’t been removed. Scrotal support underwear helps reduce the risk of intrascrotal haematoma. Both the bruising and the haematoma will disappear over time.

    Effect on fertility – losing one testicle shouldn’t affect your ability to have children (fertility), as long as the remaining testicle is healthy. Your fertility may be affected if you have chemotherapy after surgery. 

    Emotional effects –losing a testicle may cause some men to feel embarrassed, depressed or suffer from low self-esteem. It may help to talk about how you are feeling with someone you trust such as a partner or counsellor.

    Body image issues – some men choose to replace the removed testicle with an artificial one (prosthesis). 

    Having a prosthesis

    You may be given the option of replacing the removed testicle with an artificial one. This is called a prosthesis, and it is a silicone implant intended to have the weight and feel of a normal testicle.

    Whether or not you have a prosthesis is a personal decision.

    If you choose to have a prosthesis, you can have the operation at the same time as the orchidectomy or later. Your urologist can give you more detailed information about your options and what the procedure involves.

    Further surgery

    Retroperitoneal lymph node dissection 

    If the cancer has spread to the lymph glands (lymph nodes) in your abdomen, you may have an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) to remove them.

    Men with non-seminoma – may have an RPLND if scans after chemotherapy show remaining cancer cells. An RPLND will also detect whether another type of abnormal tissue called mature teratoma is present. Teratoma is not cancer but it may turn into cancer later on, so it should be removed.

    Men with seminoma – an RPLND is usually not needed as the cancer cells in the lymph nodes can be destroyed through chemotherapy or radiotherapy. However some men with more advanced seminoma cancer have this procedure.

    This surgery can be done in two ways depending on the stage of the cancer: a large incision may be made from the breastbone (sternum) to below the bellybutton (an open procedure) or the surgeon may make a smaller cut and insert the surgical tools (laparoscopy or keyhole surgery).

    The procedure can take several hours depending on how many lymph nodes need to be removed.

    Side effects of RPLND

    It can take many weeks to recover from a RPLND – at first you will probably be very tired and not be able to do as much as you used to.

    The main side effects are abdominal pain and tenderness. Tell your doctor or nurses if you are in pain as they can prescribe medication to make you more comfortable.

    An RPLND may also damage the nerves that control ejaculation. This can cause a problem known as retrograde ejaculation which is when sperm travels backwards into the bladder rather than forwards out of the penis. Although this is not harmful to the body it can cause infertility. 

    If having children is important to you it’s advisable to store some sperm before a RPLND. It may also be possible to have surgery to protect the nerves that control ejaculation (nerve-sparing surgery). Talk to your doctor for more information about this procedure.

    Surveillance policy

    If you had an orchidectomy and the cancer was completely removed along with your testicle, you may not need further treatment. Instead your doctor will monitor you with regular blood tests (checking tumour markers), chest x-rays and CT scans for at least five years. This is called surveillance.

    Surveillance can detect if there is any cancer remaining (residual cancer). It can also help determine if the cancer has come back (recurrence).

    The number of check-ups and scans will depend on the type of testicular cancer you have, seminoma and non-seminoma cancers have different patterns of recurrence so surveillance will be tailored to your circumstances.

    Radiotherapy

    Radiotherapy uses high-energy x-rays to kill cancer cells or damage them so they cannot multiply. It is sometimes given to men with seminoma cancer after surgery to prevent the cancer from coming back or to destroy any cancer cells that may have spread.

    Treatment is carefully planned to make sure as many cancer cells as possible are destroyed while causing the least possible harm to normal tissue. During a radiotherapy session you will lie under a machine called a linear accelerator which directs the x-ray beams at the cancer site.

    The unaffected testicle may be covered with a lead barrier to help preserve your fertility.

    Radiotherapy is painless and can’t be felt. Most men have outpatient treatment sessions at a radiotherapy centre from Monday to Friday for 2–4 weeks. Your doctor will advise you on the number of sessions you need to have.

    Side effects of radiotherapy

    Radiotherapy most commonly causes skin reactions, fatigue and stomach problems. However, side effects usually disappear within a few days of finishing treatment.

    Skin reaction – the skin in the treatment area may become red or irritated. Moisturising cream, such as sorbolene or calendula, should be applied to the skin when treatment starts – talk to your medical team about any other products they recommend.

    Fatigue – this can build up over time. Plan your activities during the day so you can rest regularly. It may also help to talk to your family, friends or employer about how they can help you.

    Stomach problems – the radiotherapy area may include your abdomen and this may cause stomach pain, nausea and bloating. Your doctor may prescribe medication to prevent these symptoms from occurring or to treat them if they do occur.

    Bowel problems – bowel irritations, including diarrhoea and cramping, are common. Medication and watching what you eat can help. Call 13 11 20 for information about nutrition and cancer.

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

    Bladder irritation – your 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 – radiotherapy may cause reduced sperm production or damage to sperm. This may be temporary or permanent. Speak with your doctor about sperm banking before starting radiotherapy.

    Secondary cancers – rarely, men who have radiotherapy for seminoma cancer are at a slightly increased risk of developing secondary cancers in the area of the body exposed to radiation. If you do have radiotherapy you will have regular check-ups after treatment to test for cancer.

    You will see your radiation oncologist 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. 

    Chemotherapy

    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. If the cancer is contained in the testicle it can usually be treated with surgery alone and chemotherapy is not needed.

    This treatment may be given:

    • if the cancer has spread outside your testicle
    • after surgery or, less commonly, with radiotherapy (adjuvant treatment) if there is a moderate risk of the cancer spreading or returning
    • as the primary treatment if the cancer has spread to other parts of your body.

    Chemotherapy is administered into a vein (intravenously) through a drip. 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.

    Treatment schedules vary – your doctor will give you more information.

    Side effects of chemotherapy

    Chemotherapy can affect the healthy, fast-growing cells in your body such as hair cells or cells lining the mouth and stomach, causing side effects. Everyone reacts differently to chemotherapy. Some men don’t experience any side effects while others have a few.

    Side effects are usually temporary and medication can often help reduce your discomfort. Talk to your doctor or nurse about any side effects you have and ways to manage them.

    Tiredness – most men 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, if after hours, 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. However anti-nausea medicine can prevent or reduce this feeling. Medication is available in many forms including oral tablets, wafers that dissolve on the tongue, and suppositories. Tell your medical team if you feel nauseated.

    Constipation – medication taken to prevent nausea and vomiting can cause constipation. Your medical team can prescribe something for this.

    Hair loss – chemotherapy often causes hair loss from the head and body but it 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 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.

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

    Ringing in the ears – some chemotherapy drugs can cause short-term ringing or buzzing in the ears, known as tinnitus. This can be temporary or permanent 

    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 before and after treatment.

    Risk of other cancers – men who have chemotherapy for testicular cancer are at a slightly higher risk of developing secondary leukaemia. This 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

    Chemotherapy drugs may remain in your body for a few days after treatment and they can be passed into body fluids such as urine and semen.

    If you have sex within seven days after a treatment session protect your partner from your body fluids by using a condom. Your doctor or nurse can give you more information about how long you need to use this protection – it may be 6–12 months.

    Although chemotherapy drugs and radiation can affect sperm production and damage sperm you may still be fertile and able to father a child. As the treatments can harm an unborn baby it is important that your partner does not become pregnant while you’re having treatment and for a period of time afterwards as advised by your doctor.

    This website page was last reviewed and updated January 2017.

    Information last reviewed September 2016 by: A/Prof Declan Murphy, Urologist, Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; A/Prof Joseph McKendrick, Medical Oncologist, Eastern Oncology, Eastern Health and Monash University, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia, WA; Ben Peacock, Consumer; and Deb Roffe, Cancer Council Nurse, Cancer Council SA.

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