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How is testicular cancer treated

Treatment options for testicular cancer

Treatment options may vary slightly around the country; however the following information should be relevant to most situations. 

Once you have had an orchidectomy your follow up care will usually be carried out by an oncologist who will specialise in deciding whether any further treatment is needed. However, if you had advanced disease to begin with and had to have treatment such as chemotherapy first; you may be referred to a urologist afterwards for orchidectomy.

To ensure that you get the best possible treatment in line with current national and international cancer guidelines your particular circumstances will be discussed at a specialist medical forum called a Multi-Disciplinary Team meeting (MDT).

The MDT Process

An MDT will consist of a group of medical experts including urologists, oncologists, histo-pathologists, radiologists (X-ray specialists) and other health care professionals. They will discuss your particular medical case taking into account the results of your operation and cancer findings along with your blood tests and scan results. They will then come up with a consensus opinion as to what if any, further treatment is needed. This will then be explained to you when you attend a follow up clinic appointment. Any decision made will reflect their experience in dealing with similar cases to yours and will be based on the latest medical research and techniques. The recommendation or outcome of the meeting will be in your best interest. However you can ask for a second opinion if you wish or refuse the recommended treatment plan.

SEMINOMA:  

Stage 1 seminoma (early stage)

There are usually two options for early seminoma disease, surveillance or single dose chemotherapy. Surveillance involves strict follow up appointments along with routine X-rays, scans and blood tests. For some men this is difficult due to work or other commitments and if there is a possibility that they will not be able to follow the regime, a single dose of chemotherapy may be recommended instead to prevent the risk of any future recurrence of the cancer. This will usually involve one dose of chemotherapy (Carboplatin) lasting 1.5 hours administered through a drip. It will be performed as a day case procedure. Although you may suffer some side effects for up to 7-10 days after treatment it is very successful in minimizing the chance of your cancer returning.

A third option is radiotherapy (the use of high energy waves to kill the cancer cells) to treat the lymph nodes in your back which may still harbor some disease. This treatment usually involves around 21 days of treatment with up to 10 minutes of radiotherapy each day. Side effects vary from person to person but, for many, its success rate at reducing recurrence still outweighs its effect on a patient’s lifestyle. Some studies however suggest that there is a risk of developing a secondary cancer as a result of treatment later on in life.

Both radiotherapy and chemotherapy have the same chance of preventing your cancer coming back.

If your cancer is found to be at an early stage, but you have had a history of undescended testicle or are under the age of 31 or have a smaller than usual testicle, the risk of getting testicular cancer in your other testicle is slightly higher. In this situation it will usually be recommended that you have chemotherapy to significantly reduce the risk of recurrence. 

NON-SEMINOMA: 

Non seminoma cancers can be divided into high or low risk groups depending on whether the cancer was totally confined to the testicle ( low risk), or whether there is any evidence that the cancer has infiltrated the local blood supply around the affected area (high risk). For low risk cases surveillance may still be an option although you can opt for additional chemotherapy if you wish. If you fall into the high risk category then further treatment with chemotherapy will usually be recommended.

After your treatment has been completed, your oncologist will want you to have regular check-ups which will include blood tests, scans and x-rays. These will continue for several years. A typical programme of follow up may be similar to the following regime:

Year1 - Monthly to 6-weekly clinic visits along with tumour marker blood tests and chest X-ray, with CT scans being performed at 6 and 12 months.

Year2- Monthly clinic visits with markers and chest X-ray with a CT scan at 24 months.

Years 3, 4 and 5- 3-monthly clinic visits with chest X-ray and markers.

Thereafter annually with a chest X-ray and markers for up to 10 years.

If you have any problems, or notice any new symptoms in between these times, you should let your specialist know as soon as possible. Any recurrence of testicular cancer will usually occur within 2 years of treatment. Only about 5% of relapses will occur after this.

You should continue to perform Testicular Self Examination of your healthy testicle.

CANCER TREATMENT OPTIONS EXPLAINED:

• CHEMOTHERAPY
• RADIOTHERAPY

 CHEMOTHERAPY

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells and as they circulate in the blood and can reach cancer cells all over the body. The drugs most commonly used to treat testicular cancer are Cisplatin, Etoposide and Bleomycin. A combination of all three is a treatment is known as BEP.  To see an example of a BEP treatment plan click here.

BEP chemotherapy can be given an outpatient treatment day patient or during a short stay in hospital. Blood tests will usually need to be performed prior to BEP to check that your immune system is healthy enough to cope with the treatment. A drip will be sited into a vein in your hand, arm or neck and the chemotherapy administered through it. Anti-sickness (anti-emetic), drugs can be given to you through these tubes as well. BEP chemotherapy can be given in different ways and the exact duration of your treatment will be decided by your oncologist. It can be given as a regime over three days or five days on an inpatient or outpatient basis. The treatment regime is also known as a cycle and will run over three weeks.    

For further information on  chemotherapy please click here 

RADIOTHERAPY

Radiotherapy (the use of high energy waves to kill the cancer cells) has also traditionally been offered to men with seminoma either to prevent the cancer coming back after surgery or to treat disease that has spread just to the lymph nodes/glands.

This treatment usually involves around 21 days of treatment with up to 10 minutes of radiotherapy each day. Side effects vary from person to person but, for many, its success rate at reducing recurrence still outweighs its effect on a patient’s lifestyle. Some studies however suggest that there is a risk of developing a secondary cancer as a result of treatment later on in life.