This information is an interpretation of various studies that have been published in medical journals. The information below represents various views of nurses and doctors who serve on the American Cancer Society’s Cancer Information Database Editorial Board.
Keep in mind that the information provided in this article is not designed to be taken as medical advice or to replace the opinion and judgment of your personal cancer care team. It is simply designed to help you make informed decisions together with your doctor. The general treatment options that will be discussed may not be what your doctor recommends, and there may be various reasons why. You should take the time to find out what specific treatments doctors recommend for you.
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The primary treatment for testicular cancer is surgery. Depending on the extent and severity of the spread, the following surgeries may be utilized:
Surgery to remove a cancerous testicle, known as a radical inguinal orchiectomy, involves making an incision above the pubic area and gently removing the testicle from the scrotum. The entire tumor, along with the testicle and spermatic cord, is then removed by the surgeon. These vessels are tied off early in the operation to reduce the risk of cancer spreading. This surgical procedure is typically used to treat all types of testicular cancer, even those that have metastasized.
Depending on the type of testicular cancer, lymph nodes may also need to be removed to stop the cancer from spreading. Lymph nodes around the aorta and inferior vena cava, and the abdomen may be removed at the same time as the orchiectomy, or during a follow-up operation. This is a complex procedure that requires experienced surgeons.
This can also be done through laparoscopic surgery. A laparoscope is a thin, hollow tube with a camera at the end that can also be fitted with special tools for surgery. After sedation, small incisions are made in the abdomen to allow a laparoscope to pass through. This allows for less invasive lymph node removal and faster recovery time. However, it is debated whether this type of surgery can be as thorough and effective as open surgery.
Removing both testicles results in infertility. However, it is possible to conceive even with just one testicle. Testicle removal also hampers regular hormone production, so men who have gone through an orchiectomy may need testosterone replacement therapy to maintain regular bodily functions. A prosthetic testicle may also be implanted in the scrotum if a more natural look is desired after surgery. Lymph node surgery typically does not cause severe side effects, but if nerves are damaged, a condition known as retrograde ejaculation, where sperm shoots in the opposite direction and into the bladder can occur. This is why it is important to have experienced doctors perform lymph node removal. It is advised that men who are planning to undergo orchiectomy freeze and store sperm in sperm banks if they still desire to have children in the future, should any complications arise.
Radiation therapy is used principally for testicular cancer patients with seminoma because seminoma cells are more sensitive to radiation. High-energy X-rays are focused from an outside source into predetermined paths and angles to kill cancer cells in separate radiation therapy sessions. Radiation may also be used as adjuvant therapy to keep cancer cells from returning by killing the lingering cells after surgery. It is also useful for treating cancer that has spread to other parts of the body.
Fatigue, nausea, and diarrhea are common immediate side effects of radiation therapy. But in more severe cases, radiation that leaks into the healthy testicle can cause lowered sperm counts and damage blood vessels. To prevent radiation leaks, a radiation shield is fitted into the healthy testicle before radiation doses are administered.
Chemotherapy uses powerful anti-cancer drugs, administered intravenously or through pills to treat testicular cancer. It is given in cycles with rest periods in between because these drugs are incredibly taxing on the body and may cause deterioration with prolonged use. These are systemic treatments and are further-reaching than localized treatments like surgeries and radiation, so they can also be effective at fighting cancer that has already spread to other parts of the body.
The following drugs are commonly used for chemo in testicular cancer:
The combinations and specific drug choices will be determined by your cancer team after a thorough examination of your condition. Chemo drugs attack cells that divide quickly. This is why they are effective against cancer cells. But they will also attack bone marrow and hair follicles because they are non-selective. This can lead to the following side effects:
Constant monitoring during and after chemotherapy is crucial for ensuring that side effects can be managed properly, or that a second type of cancer does not develop because the body has severely deteriorated.
Stem cell transplants allow doctors to use higher doses of chemo to treat testicular cancer. Before treatment, a special machine collects blood-forming stem cells from the patient's bloodstream, which are then frozen and stored. The patient subsequently receives high-dose chemo. Following the chemo treatment, the patient's stem cells are returned to their body through an infusion, similar to a blood transfusion. The stem cells settle in the bone marrow and begin producing new blood cells over the following weeks.
Stem cell transplants are most commonly used to treat testicular cancers that have recurred after initial chemotreatment. Ongoing studies are investigating whether stem cell transplants may also be beneficial as part of the first-line treatment for some patients with advanced germ cell cancers. However, stem cell transplants are complex procedures that can cause life-threatening side effects due to the high doses of chemotherapy used.
Patients should carefully consider the potential benefits and risks before proceeding with a transplant, and the procedure should be performed at a hospital with experienced staff. Additionally, stem cell transplants can be costly and may require a lengthy hospital stay, so patients should discuss insurance coverage and potential out-of-pocket expenses with their healthcare provider before making a decision.
If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your testicular cancer or from negligence during your treatment that caused you more harm, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are.
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