Therapy is based on the type of tumor, location, and prognosis. It’s also critical to know the stages of testicular cancer. Staging occurs during diagnosis and ranges from early-stage disease to stage III testicular cancer, which means the cells have already begun to spread to lymph nodes, the abdomen or perhaps the lungs.
Sometimes testicular cancer treatment can cause infertility and affect male hormone levels. Men who wish to have children can bank their sperm before treatment begins. If one healthy testicle remains in place, fertility usually returns about two years after cancer treatment.
Some patients' cases are discussed at Wilmot's multidisciplinary tumor board — a conference that is attended by all different specialties required for your care.
Five types of treatment are used for testicular cancer: surgery, radiation, chemotherapy, surveillance, high-dose chemo with stem cell transplant.
As described above in the diagnostic process, doctors can remove one or both testicles and some of the nearby lymph nodes. This is called a radical inguinal orchiectomy. Sometimes a second operation is needed to remove lymph nodes at the back of the abdomen. Laparoscopic surgery to remove lymph nodes is another option, but that approach is usually not as thorough as an abdominal incision and open surgery.
Losing a testicle usually has no impact on the ability to get an erection and have sex. However, testicular cancer surgery can raise concerns about appearances. To restore a more natural look, surgeons can implant a testicular prosthesis into the scrotum. If both testicles are removed, the decrease in hormone levels does result in sexual dysfunction, which can be treated with testosterone supplements.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and eradicate cancer cells. The way radiation is given for testicular cancer depends on the type of tumor and stage of cancer. Usually patients receive this treatment if they have a seminoma tumor, which is sensitive to radiation.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. It can be used to try and cure testicular cancer that has spread outside the testicle, or as a follow-up treatment to surgery. For patients whose cancer has already spread to distant sites in the body, several types of treatment could be used.
Because this type of cancer affects young men, doctors are concerned about how chemotherapy treatment might impact the patient later in life. While it is sometimes necessary to use chemo to cure testicular cancer, the risks of chemotherapy-related hearing loss, heart, kidney, or lung damage, and second cancers, are a factor for many years. Wilmot has published research that illuminates these risks.
This means that doctors will closely monitor a patient without recommending any treatment, unless test results change. This approach is used to find early signs that the cancer has returned.
High-dose chemotherapy with stem cell transplant
This is a two-step, complex treatment that involves higher doses of chemo than with standard chemotherapy. Even though it’s called a transplant, it does not involve surgery. For testicular cancer, this approach can be used if the cancer returns after initial treatment.
Before the transplant process begins, doctors collect either the patient’s own blood-forming stem cells, which are frozen and stored, or stem cells from an appropriately matched healthy donor. (The type of transplant is dependent upon many factors, including the patient’s specific diagnosis.) Then the patient receives high doses of chemotherapy; after chemo is completed the patient’s own stem cells or donor cells are infused back into the patient’s vein like a blood transfusion. The cells then settle into to the bone marrow and begin making new blood cells.
A stem cell transplant can cause life-threatening side effects. It’s important to talk to your doctor about the risks and benefits. Wilmot Cancer Institute has one of the largest transplant programs in New York State. Wilmot also evaluates each case and coordinates care to decrease the length of stay at the hospital when possible.
Many cancer treatments cause side effects such as hair loss or fatigue. Some people have side effects and others don’t.
Wilmot has one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.