Treatment options for testicular cancer

A team of health professionals (multidisciplinary team) decides your treatment plan.

Most people have surgery to remove their testicle as their first treatment for testicular cancer. After surgery you might need further treatment such as chemotherapy or radiotherapy. And you might need another operation to remove lymph nodes from the back of your tummy (abdomen).

If your cancer has spread beyond your testicle, you might have chemotherapy as your first treatment, before surgery to remove your testicle.

Deciding what treatment you need.

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a specialist urology MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team usually includes:

a specialist surgeon (urologist)
cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
a specialist cancer nurse (also called clinical nurse specialist)
a pathologist (an expert who examines any cancer or tissue the surgeon removes)
a pharmacist
a radiologist (who looks at your scans and x-rays)

Your treatment depends on:

how far your cancer has grown or spread and the level of particular proteins (markers) in your blood (the stage)
the type of cancer (seminoma or non seminoma)
your risk factors for the cancer coming back
your general health and level of fitness

Factors that might affect the risk of your cancer coming back include:

whether the cancer has spread into lymph vessels or blood vessels around the cancer - this is called lympho vascular invasion (LVI)
whether the cancer has spread into the network of small tubes in your testicle (rete testis)
the size of your cancer

Your doctor will discuss your risk of the cancer coming back. They usually discuss further treatment such as chemotherapy, radiotherapy and further surgery. They will tell you about the benefits and the possible side effects.

The main treatments

Surgery is usually the first treatment for testicular cancer. After surgery you might have one of the following or a combination of them:

monitoring (surveillance)
chemotherapy
radiotherapy

Surgery

You have surgery to remove your testicle as your first treatment. This surgery is called an orchidectomy or orchiectomy.

You might also have surgery to remove:

lymph nodes in your tummy (retroperitoneal lymph node dissection)
secondary cancer in your lungs

Monitoring (surveillance)

You might not need further treatment after surgery if the risk of your cancer coming back is low. But you will have regular tests. These are to check for early signs of the cancer coming back so that it can be found and treated early. Doctors call this surveillance.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

Chemotherapy is a common treatment if you have a higher risk of your cancer coming back, or your cancer has already spread. You usually have a combination of chemotherapy drugs. You have the drugs into your bloodstream by injection or through a drip (intravenously).

Radiotherapy

Radiotherapy uses high energy waves similar to x-rays to kill cancer cells.

You might have radiotherapy if seminoma testicular cancer has spread to the lymph glands at the back of your tummy (abdomen).

Sperm banking before treatment

Chemotherapy and radiotherapy treatments can affect your fertility. Collecting sperm before treatment means you might still be able to have a baby in the future if you want to. You can freeze and store sperm until you decide you want to use it.

Your doctor will offer you the chance to store 2 or 3 semen samples (called sperm banking) before your treatment starts.

Treatment by cancer stage

The treatment you have depends on several factors, including your cancer stage. There are 3 main testicular cancer stages - stage 1, 2 and 3.

Stage 1

You have surgery to remove the testicle.

Your doctor will talk to you about the risk of your cancer coming back and whether further treatment might be an option.

You don't need further treatment if your risk of the cancer coming back is very low. Your doctor monitors you regularly to see if the cancer comes back. This is called surveillance.

Your doctor might suggest further treatment if you are at a high risk of your cancer coming back. Or if you are unable to or don't want to have surveillance. Your treatment depends on your cancer type.

Seminoma
You might have one cycle of a chemotherapy called carboplatin.

Rarely, your doctor might suggest radiotherapy if you are unable to have surveillance or chemotherapy.

Non seminoma
You might have:

one cycle of a combination of chemotherapy drugs called BEP
surgery to remove lymph nodes in your tummy (retroperitoneal lymph node dissection) if you can't have chemotherapy

Stage 2A and 2B

Your treatment plan depends on the stage of your cancer and your tumour marker levels.

Your first treatment is likely to be surgery to remove your testicle.

You might not have further treatment straight away. Your doctor might wait for 6 to 8 weeks and then repeat a scan of your tummy. This to see if your lymph nodes have grown. It helps to confirm whether the cancer has spread to your lymph nodes in the back of your tummy.

Seminoma

You might have:

3 cycles of BEP chemotherapy or 4 cycles of EP chemotherapy
3 or 4 cycles of carboplatin (doctors call this carboplatin AUC10)
radiotherapy

Non seminoma

You might have one or both of the following treatments:

surgery to remove lymph nodes in your tummy (retroperitoneal lymph node dissection)
chemotherapy - the type of chemotherapy and number of cycles depends on your situation

Stage 2C and stage 3

For stage 2C and 3 testicular cancer (seminoma and non seminoma) you usually have chemotherapy after surgery to remove your testicle.

You usually have BEP chemotherapy. Or you might have EP chemotherapy. Your doctor will tell you how many cycles you need.

Seminoma

After chemotherapy, you don't usually need further treatment. Your doctor will monitor you regularly. You will need further treatment if tests show your cancer is still growing.

Non seminoma

After chemotherapy, you might have surgery. This is to remove lymph nodes in the back of your tummy (abdomen) or cancer cells in the lung. You only have the surgery if the cancer hasn't shrunk completely and doctors can still see it on the scan.

Treatment if your cancer comes back

You usually have chemotherapy if your cancer comes back. The choice of drugs depends on many different factors. Your doctor might offer you high dose chemotherapy.

You might also have surgery or radiotherapy.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.