Treatment options for testicular cancer

A team of health professionals will discuss the best treatment for you. This depends on factors such as your cancer stage and grade. 

There are different treatment options for testicular cancer. These are:

• surgery

• monitoring (surveillance)

• chemotherapy

• radiotherapy

Most people have surgery to remove their testicle as their first treatment for testicular cancer. After surgery you might need further treatment such as chemotherapy or radiotherapy . And you might need another operation to remove lymph nodes from the back of your tummy (abdomen).

If your cancer has spread beyond your testicle, you might have chemotherapy as your first treatment.

Deciding what treatment you need.

A team of doctors and other professionals discuss your treatment options. They are called a multidisciplinary team (MDT). 

Most people are referred to a specialist urology MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team might include:

• a specialist surgeon (urologist)
• cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
• a clinical nurse specialist - a qualified nurse who has specialist knowledge of testicular cancer. They help to organise your care between doctors and other health professionals
• a pathologist (an expert who examines any cancer or tissue the surgeon removes)
• a pharmacist
• a radiologist (who looks at your scans and x-rays)
• social workers or benefits advisers
• MDT coordinator who makes sure all your results are ready and appointments are booked

Your treatment depends on:

• how far your cancer has grown or spread and the level of particular proteins (markers) in your blood (the stage)

• the type of cancer (for example, seminoma or non seminoma)

• the risk of the cancer coming back

• your general health and level of fitness

Factors that might affect the risk of your cancer coming back include:

• whether the cancer has spread into lymph vessels or blood vessels around the cancer - this is called lympho vascular invasion
• whether the cancer has spread into the network of small tubes in your testicle (rete testis)
• the size of your cancer

Your doctor will discuss your risk of the cancer coming back. They usually discuss further treatment you might need, and will explain the benefits and the possible side effects.  

Treatment overview

Surgery is usually the first treatment for testicular cancer. After surgery you might have other treatments.

Surgery

You have surgery to remove your testicle as your first treatment. This surgery is called an orchidectomy or orchiectomy. 

You might also have surgery to remove lymph nodes in your tummy (retroperitoneal lymph node dissection)

Sometimes the cancer can spread to other parts of the body. For example, it can spread to the lungs or the brain. You might have surgery to remove the cancer. Your surgeon will give you more information if you need to have this specialised surgery.

Monitoring (surveillance)

You might not need further treatment after surgery if the risk of your cancer coming back is low. But you will have regular tests. These are to check for early signs of the cancer coming back so that it can be found and treated early. Doctors call this surveillance. 

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream. 

Chemotherapy is a common treatment if you have a higher risk of your cancer coming back, or your cancer has already spread. You usually have a combination of chemotherapy drugs. You have the drugs into your bloodstream by injection or through a drip (intravenously).

Radiotherapy

Radiotherapy uses high energy waves similar to x-rays to kill cancer cells.

You might have radiotherapy if seminoma testicular cancer has spread to the lymph glands at the back of your tummy (abdomen).

Sperm banking before treatment

Some treatments for testicular cancer can affect your fertility . Collecting sperm before treatment means you might still be able to get someone pregnant in the future. You can freeze and store sperm until you decide you want to use it.

Your doctor will talk to you about storing sperm (called sperm banking) before your treatment starts.

Treatment by cancer stage

The treatment you have depends on several factors, including your cancer stage. There are 3 main testicular cancer stages - stage 1, stage 2 and stage 3.

Stage 1

You have surgery to remove the testicle. 

Your doctor will talk to you about the risk of your cancer coming back and whether further treatment might be an option.

You don't need further treatment if your risk of the cancer coming back is very low. Your doctor monitors you regularly to see if the cancer comes back. This is called surveillance. 

Your doctor might suggest further treatment if you are at a high risk of your cancer coming back. Or if you are unable to or don't want to have surveillance. Your treatment depends on your cancer type.

Seminoma
You might have one cycle of a chemotherapy called carboplatin.

Rarely, your doctor might suggest radiotherapy if you are unable to have surveillance or chemotherapy.

Non seminoma
You might have:

• one cycle of a combination of chemotherapy drugs called BEP 
• surgery to remove lymph nodes in your tummy (retroperitoneal lymph node dissection) if you can't have chemotherapy

Stage 2A and 2B

Your treatment plan depends on the stage of your cancer and your tumour marker levels.

Your first treatment is likely to be surgery to remove your testicle.

You might not have further treatment straight away. Your doctor might wait for 6 to 8 weeks and then repeat a scan of your tummy. This to see if your lymph nodes have grown. It helps to confirm whether the cancer has spread to your lymph nodes in the back of your tummy. 

Seminoma

You might have:

• 3 cycles of BEP chemotherapy or 4 cycles of EP chemotherapy
• radiotherapy

Non seminoma

You might have one or both of the following treatments:

• surgery to remove lymph nodes in your tummy (retroperitoneal lymph node dissection) 
• chemotherapy - the type of chemotherapy and number of cycles depends on your situation

Stage 2C and stage 3

For stage 2C and 3 testicular cancer (seminoma and non seminoma) you usually have chemotherapy after surgery to remove your testicle. 

You usually have BEP chemotherapy. Or you might have EP chemotherapy. Your doctor will tell you how many cycles you need.

After chemotherapy, you don't usually need further treatment. But some people might have surgery. This depends on your type of testicular cancer. Your doctor will check you regularly. You will need further treatment if tests show the cancer hasn't shrunk or is still growing. 

Treatment if your cancer comes back

You usually have chemotherapy if your cancer comes back. The choice of drugs depends on many different factors. Your doctor might offer you high dose chemotherapy.

You might also have surgery or radiotherapy.

Clinical trials

Your doctor may ask if you’d like to take part in a clinical trial.

Doctors and researchers do trials to:

• improve treatment

• reduce the side effects of treatment

• develop new treatments

Getting a second opinion

Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful.