Testicular Cancer Treatments: More Options, Better Outcomes

Ninety percent of testicular cancer patients are cured at Roswell Park. Dr. Levine explains.

We take a multidisciplinary approach to testicular cancer treatment. A team of surgical, medical and radiation oncologists, pathologists and other urology specialists collaborate to determine the best treatment plan for each patient based on the stage of the cancer, age, general health and other factors.

Surgery

Surgery to remove the testicle and some of the lymph nodes may be done to diagnose and stage testicular cancer. Even if all signs of cancer are removed during surgery, some patients may also be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells.

Radical Inguinal Orchiectomy

A procedure to remove the entire testicle through an incision in the groin. The testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy because, if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.) If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment.

Some of the lymph nodes located deep in the abdomen may be removed during an orchiectomy in a procedure called a retroperitoneal lymph node dissection.

Chemotherapy

Advances in chemotherapy (the use of anti-cancer drugs to kill cancer cells throughout the body) during the 1970s have made testicular cancer one of the most curable solid tumors, with a five-year survival rate of over 95 percent. It is most often used in conjunction with surgery to treat testicular cancer. (Treatment given after the surgery, to lower the risk that the cancer will come back is called adjuvant therapy.)

Chemotherapy is a systemic therapy, meaning that drugs travel throughout your body via the bloodstream and affect normal as well as cancerous cells. Side effects depend largely on the specific drug(s) being used, your general health, and the dose. Some common side effects include bone marrow depression (increased risk for bleeding, anemia, and infection), fatigue, nausea/vomiting, rash, and/or hair loss. If you will be having chemotherapy, you will be given complete information about the specific drugs in your regimen.

Radiation

Radiation therapy, also called radiotherapy, uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation therapy for testicular cancer comes from a machine outside the body (external beam radiation) and is usually aimed at lymph nodes in the abdomen. Radiation therapy is a local therapy; it only affects the cells in the treated areas.

Seminomas, the most common type of testicular cancer, are highly sensitive to radiation and the treatment cycle may be as short as two weeks. Radiation is usually done after surgery and can also be used after chemotherapy if any cancer remains. Even if the cancer returns, it is still very treatable with either radiation or chemotherapy in the majority of cases.

Nonseminomas are less sensitive to radiation, so men with this type of cancer usually do not undergo radiation.

Radiation therapy interferes with sperm production, but many patients regain their fertility over a period of 1 to 2 years.

Stem Cell Transplantation

A more recent treatment option for men with advanced testicular cancer, stem cell transplantation allows physicians to prescribe higher-dose chemotherapy, which would otherwise damage bone marrow where new blood cells are made. In this procedure, stem cells are taken from the patient’s bloodstream and frozen prior to high-dose chemotherapy treatment. After treatment, the stem cells are transplanted back into the body where they settle in the bone marrow and begin generating new blood cells.

The Roswell Park Advantage

Philip McCarthy, MD, leads Roswell Park's BMT team, treating testicular cancer patients who receive stem cell transplantation.Testicular cancer patients receiving stem cell transplantation are treated through the Blood and Marrow Transplant (BMT) Program. Established in 1991 the BMT program is certified by the National Marrow Donor Program as a Transplant, Collection and Apheresis Center. The BMT team, under the direction of Philip McCarthy, MD, offers both autologous (self-donated) and allogeneic (requiring a related or unrelated donor) transplantation of peripheral blood stem cells, bone marrow or cord blood.