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HIV and Testicular Cancer

This information is for men with the human immunodeficiency virus (HIV) who have recently been diagnosed with testicular cancer.

Managing your anti-HIV treatment alongside treatment for testicular cancer can be complex and you will need to see a different doctor for each treatment. But your out-patient clinic and medical teams should work together. Each hospital or specialist healthcare team will manage your disease slightly differently and the treatment you receive will also be dependent on your general health, the status of your immune system and any other conditions you may have such as hepatitis or TB.

Who is affected?

Testicular cancer is the most common cancer in men aged 15-35. Every year over 2,000 men will be diagnosed with the disease.

Men with HIV will have a slightly higher incidence of testicular cancer (approximately double the risk compared to HIV negatives) although it is not as common as Kaposi's sarcoma and non-Hodgkins lymphoma. The reason for this increased risk in HIV positives is not clear.

Treatment options: how is this decided?

Fortunately, testicular cancer is highly treatable in HIV negatives. If caught early, 98% of men will make a full recovery, and even in the later stages of the disease, 90% of men will make a full recovery. Early in the HIV pandemic it was feared that testicular cancer in HIV positives may be more aggressive and associated with a less good outcome. However, more recent data suggests this is not the case. Providing testicular cancer in HIV positives is treated in an identical manner to HIV negatives, the outcome appears to be the same.

Your specialist healthcare team will have carried out a series of blood tests, examinations and scans (such as a CT scan of the chest, abdomen and pelvis) to identify the type of cancer you have and whether is has spread beyond the testicle. This will help to determine the best course of treatment.

Treatment options: what are they?

There are 3 possible types of treatment available to you: surgery, radiotherapy and chemotherapy.

Surgery

Removing the affected testicle and tumour by surgery (orchidectomy) is the standaard treatment for testicular cancer where the cancer has remained within the testicle(s). This is usually done quickly and within a two week period. It will not adversely affect your sexual performance and a prosthesis - or false testicle - can be inserted in place of the removed one. This tends to be performed a few months after the initial operation. Another option is surgery involving a lumpectomy where just the tumour is removed, although this is only possible under specific conditions ans is not considered standard treatment in many settings.

After surgery it is not necessary to give any further treatment, providing the cancer has not spread beyond the testicle. This form of treatment is known as surveillance. Unfortunately the cancer returns or relapses (usually at the site of the lymph nodes in the abdomen) in about 30% of patients. This is true for both HIV positives and negatives alike. Almost all of these patients are cured with chemotherapy however the chemotherapy does have side effects and can be bad for your CD4 count (it causes a 50% fall).

Radiotherapy

Due the effect chemotheray has on your CD4 count some doctors offer either radiotherapy or mild chemotherapy to prevent the cancer coming back. This milder treatment has a much less profound effect on your immune system and some patients opt for this extra treatment for preventative purposes. If you have an early stage non-seminoma you may not receive treatment immediately. It is likely that you will be monitored and treated.

Radiotherapy is not widely used in HIV positive testicular cancer patients. If the disease has only spread to a very small number of lymph nodes in the abdomen (stage 2) radiotherapy could be an option, although most oncologists would still advise chemotherapy. Additionally we know that radiotherapy is also bad for the immune parameters.

Chemotherapy

If it is apparent that the cancer has spread beyond the testicle you will almost certainly need chemotherapy. HIV positives have an excellent outcome if treated with the same chemotherapy drugs as their HIV negative counterparts (cisplatin bleomycin and etoposide). These drugs can be bad for your HIV parameters (CD4 count and viral load) in the short term (although a full recovery is seen over 6 months). Therefore close collaboration between the HIV doctors and the oncologists is required and prophylactic treatment against opportunistic HIV related infections may be required.

For frequently asked questions about HIV and

Testicular cancer please click here 

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