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How is testicular cancer treated

Testicular cancer is highly treatable. If caught early, 98% of patients will make a full recovery, and even in the later stages of the disease, 95% of patients will make a full recovery. If you have been diagnosed with testicular cancer, there may be a number of treatment options available for you. This depends on the stage (i.e .if the cancer has spread beyond the testis) and the type of cancer cells, as there are a number of different types of testicular cancer.

Also known as germ cell cancers, the most common type is seminoma (over 50%); the remaining types (such as embryonal, choriocarcinoma and yolk sac) behave in a similar manner but are often grouped together, and called non-seminoma.

SEMINOMA
Seminomas are generally slower growing and can stay localised in the testicle for long periods of time. They usually affect men aged from 25 upwards.

NON-SEMINOMA (used to be known as teratoma)
Non-seminomas usually affect a younger group of men (from about the age of 15) and tend to be more aggressive than the other type, seminomas.

CANCER TREATMENT OPTIONS

• ORCHIDECTOMY
• CHEMOTHERAPY
• RADIOTHERAPY

ORCHIDECTOMY

CANCER THAT IS LOCALISED (stage one disease)
The standard treatment for localised disease is an orchidectomy (surgical removal of the testicle), which usually takes place within two weeks of diagnosis. The procedure is via an incision (or cut) in the groin and not through the scrotal sac. The cells are then taken to the laboratory and examined further to find out which type of testicular cancer it is. You can usually go home the same or the next day.

The removal of one testicle does not affect your ability to have an erection or to father children. An artificial testicle (known as an implant or prosthesis) can be inserted into your scrotum to restore a normal appearance. The specialist will be able to give more details.

In many cases, no further treatment is required after an orchidectomy. In 10-40% of patients however, the cancer can return, but over 90% are cured with further treatment using chemotherapy. In an attempt to reduce the chance of the cancer returning, different treatment (adjuvant treatment - see next section) such as chemotherapy or radiotherapy can be given. The adjuvant treatment does reduce the chances of the cancer coming back but can have side effects. Many doctors recommend no treatment after an orchidectomy, as the outcome from both approaches is similar. Evidence shows that both options are safe.

Patients need to be followed up on a regular basis in a clinic for at least five years with blood tests and CT scans. This is particularly true for those patients who did not receive extra adjuvant treatment, as the chance of the cancer coming back is higher.

ADJUVANT TREATMENT (for Stage one seminoma)
Radiotherapy has a high success rate. It involves 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 still outweighs its effect on a patient’s lifestyle, despite carrying a risk of secondary cancers later on in life.

Chemotherapy is another option following an orchidectomy. Recent studies have suggested that this form of treatment is now just as successful as radiotherapy. You will receive one dose of chemotherapy lasting 1.5 hours. Although you may suffer from side effects for 7-10 days, this form of treatment is much less time consuming and will change your lifestyle far less than radiotherapy.

ADJUVANT TREATMENT (for Stage one non-seminoma)
Chemotherapy for this is likely to be two courses of treatment involving a combination of chemotherapy drugs. This is less than you will need if the disease returns.

Surgery to remove the lymph nodes at the back of the abdomen may occasionally be offered in the UK. This operation is called a "retroperitoneal lymph node dissection" (RPLND).

Radiotherapy is not used for this type of testicular cancer.

"Surveillance": (seminoma & non seminoma)
Many men do not have preventative treatment but are more closely monitored in clinic. It may be possible to advise you whether your cancer has a high or low chance of coming back as, when the testis is examined in the laboratory, some tumours do have features which can suggest a higher risk of recurrence. Your specialist will be able to advise if you are one of these men, but we do not currently have a test which can predict this with certainty.

CANCER WHICH HAS SPREAD (metastasised)
Testicular cancer tends to spread to the lymph nodes in the abdomen and to the lungs. Over 80% of these patients are treated successfully with chemotherapy. Other more serious organs, to which the cancer can spread, include the liver and brain. Even so, over 50% of these patients are treated effectively with chemotherapy.

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, they can reach cancer cells all over the body. The drugs most commonly used to treat testicular cancer are cisplatin, etoposide and bleomycin – the treatment is also known as BEP. The chemotherapy drugs are given by injection into a vein (intravenously). Treatment for testicular cancer is very successful, and the cancer does not usually come back after standard chemotherapy treatment.

For the testicular cancers which have only a 50% chance of being treated effectively with the standard type of BEP chemotherapy, your specialist may advise you to have a more intensive form of chemotherapy.

CHEMOTHERAPY SIDE EFFECTS
While the chemotherapy drugs are acting on the cancer cells in your body, they may also temporarily reduce the number of normal cells in your blood. When these cells are in short supply, you may be more likely to get an infection and to tire easily. It is important to let your cancer specialist team know straight away if you feel unwell or develop a temperature at any time during your treatment.

During chemotherapy your blood will be tested regularly to make sure your white cell count recovers and your kidneys are functioning correctly. If necessary, you will be given antibiotics to treat any infection. Other common side effects of chemotherapy include: nausea and vomiting, (anti-sickness drugs will usually be given to you at the start of your treatment), mouth sores and small ulcers, (regular mouthwashes are important and your nurse will show you how to do these properly) loss of appetite, hair loss, inflammation in the lungs/shortness of breath and tinnitus (ringing in the ears).

RADIOTHERAPY

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to the normal cells. It is often used to treat seminoma but not usually to treat non-seminoma.

WHEN IS IT GIVEN IN TESTICULAR CANCER
Radiotherapy is given to some men with seminoma, either to prevent the cancer coming back after surgery (adjuvant treatment) or to treat disease that has spread just to the lymph nodes/glands at the back of the abdomen. It is a highly successful treatment, which will cure almost all men with this type of cancer.

RADIOTHERAPY SIDE EFFECTS
Radiotherapy can cause side effects such as feelings of sickness (nausea), tiredness, and diarrhoea. Most of these side effects are mild and can be treated successfully with drugs. Any side effects should gradually disappear once your course of treatment is over. While you are having radiotherapy it is important to drink plenty of fluids and have a healthy diet. If you don't feel like eating you could try supplementing your meals with high calorie drinks, which are available at most chemists (some are also available on prescription). During your treatment you should try to get as much rest as you can, especially if you have to travel a long way each day for treatment. Radiotherapy does not make you radioactive and it is perfectly safe for you to be with other people, including children, throughout your treatment.