How is testicular cancer treated?
Testicular cancer is almost always curable if it is found early. This disease responds well to treatment, even if it has spread to other parts of the body. Overall, testicular cancer has a survival rate of 95%. (Ministry of Health stats)
When testicular cancer is diagnosed, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, scans, and, in rare cases, additional surgery.
Men will have a CT or (CAT) scan of their abdomen and chest. A CT scan is a series of x-rays of specific areas of the body that helps the doctors see if the cancer has spread. In some circumstances a Positron Emission Tomography, or PET scan may be helpful.
Special blood tests can also reveal certain substances produced by some testicular cancers in the blood. These substances are called tumour markers. The levels of specific tumour markers in the blood can help the doctor determine what type of testicular cancer the patient has, how advanced it is, and whether there are signs of the tumour surviving or returning after treatment.
Treatment virtually always begins with the surgical removal of the testicle. The rare exception to the rule is if surgery is not possible for some reason. Although this is difficult to accept for many men, the testicle with cancer will usually not be producing healthy sperm effectively, and may not be producing testosterone. Even if the testicle is functioning, the other testicle almost always functions well enough alone after the surgery to maintain fertility and testosterone levels.
Since most testicular cancers are found early, removal of the testicle is often all the treatment that is required, but men need a discussion with an oncologist to learn about their personal risk of the cancer returning, and whether some follow-up chemotherapy is warranted to reduce this risk. The alternative is surveillance, involving further scans and blood tests to ensure that if the tumour returns, it is found and treated early. Radiation treatment can be used for certain types of testicular cancer, but is not commonly used now, due to the effectiveness of modern chemotherapy drugs and potential side effects.
Although uncommon in modern practice due to other effective treatments, surgery may be required to remove the lymph nodes deep in the abdomen (called RPLND surgery) in cases where tumour has spread there, and has proven resistant to chemotherapy. A pathologist then examines the nodes to determine whether they contain cancer cells. For patients with nonseminoma, removing the nodes can also help stop the spread of their disease. Seminoma patients do not usually need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.
What are the side effects of treatment for testicular cancer?
Surgery to remove the testicle is usually a relatively simple procedure under anaesthetic requiring only a day stay at hospital. Most men recover rapidly and significant complications are uncommon.
Many men worry that losing one testicle will affect their ability to have sexual intercourse or make them sterile. But a man with one healthy testicle can still have a normal erection and produce sperm. An operation to remove just one testicle does not make a patient impotent and seldom interferes with fertility. If there is a higher than usual risk of infertility, sperm banking can be performed for future fertility treatment.
If desired, men can have an artificial testicle, called a prosthesis, placed in the scrotum. The implants are not perfect however, often sitting higher in the scrotum and not feeling the same as a normal testicle. In some cases men later ask to have the prosthesis removed as they are dissatisfied with it.
If surgery to remove the lymph nodes is required, it does not change a man’s ability to have an erection or an orgasm. However, the operation can cause infertility because it may interfere with the nerves involved in ejaculation. Severing these nerves causes the bladder neck to relax during an ejaculation allowing the semen to travel backwards into the bladder instead of forward through the penis. Some men may have temporary stoppage then recover the ability to ejaculate without treatment; others may be helped by medication – for many it will be permanent. This risk is largely avoided by modern “templates” allowing surgeons to avoid areas rich with nerves.
Chemotherapy causes side effects because it damages not only cancer cells, but other rapidly growing cells as well, such as hair and gum tissue. Often anticancer drugs are given in cycles, with treatment periods alternating with rest periods. The side effects of chemotherapy depend on the specific drugs that are given and the response of the individual patient. These drugs commonly affect hair cells, blood-forming cells, and cells that line the digestive tract. As a result, they may cause various problems, including hair loss, lowered resistance to infection, loss of appetite, nausea and vomiting, and mouth sores.
Most men who receive chemotherapy for testicular cancer can continue to function sexually, although some anticancer drugs interfere with sperm production. Although this effect is permanent for some patients, many recover their fertility within a few years. Patients about to have chemotherapy who are interested in having children in the future can bank sperm, just in case.
Radiation therapy affects both normal and cancerous cells, but normal cells are usually able to recover. This form of treatment has largely been replaced by modern, highly effective chemotherapy drugs and is only effective in some specific cancer sub types, but may have a role in some patients. One major concern is that the radiation treatment itself can cause cancers years later due to normal cells being damaged. Radiation therapy may interfere with sperm production, but usually the effect is temporary, and most patients regain their fertility within a matter of months. Some other unpleasant effects of radiation therapy include diarrhoea and vomiting. These problems can usually be controlled with medication. There may also be skin reactions in the area being treated, and it is important to treat the skin gently. Lotions and creams should not be used on these areas without the doctor’s advice.
Loss of appetite can be a serious problem for patients receiving either chemotherapy or radiation therapy. Researchers are learning that patients who eat well are better able to withstand the side effects of their treatment. Therefore, good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to build and repair skin, hair, muscles and organs. Many patients find that having several small meals and snacks throughout the day is easier than trying to eat three large meals.
The side effects of cancer therapy vary from person to person and may even be different from one treatment to the next in the same patient. Attempts are made to plan treatment to minimise problems. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them.
Regular follow-up exams are very important for anyone treated for testicular cancer.
A patient who has had testicular cancer should be closely monitored for several years to be sure the cancer is completely gone.
If the cancer does recur, early detection is very important so that additional treatment can be started and the disease contained quickly.
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