Testicular Cancer Treatment
Our Treatment Approach
Treatment for testicular cancer at MD Anderson focuses on the most modern techniques in surgery, chemotherapy and other therapies. We customize your treatment to include the most advanced procedures with the least impact on your body.
Our renowned team of experts considers all the options, and then choose the best course of action specifically for you. Your personalized testicular cancer treatment may include:
- Surgery by a dedicated team of urologists, vascular surgeons, and anesthesiologists with expertise in this complex cancer
- Special nerve-sparing surgical procedures to retain as much function as possible
- The most modern restoration and prosthetic techniques
- Dose-dense chemotherapy, which allows a higher level of drugs to be given and may help prevent stem cell transplant in some patients
- Stem cell transplants at one of the premier programs in the country
Experience Matters
Because MD Anderson is one of the nation¡¯s largest cancer centers, we see a much greater number of patients with testicular cancer than do most oncologists. This is particularly important in surgery for testicular cancer, which is delicate, challenging and requires a great deal of expertise.
Studies have shown that the effectiveness of surgical treatment for testicular cancer depends a great deal on the number of procedures the surgeon has performed. MD Anderson¡¯s skilled surgeons are among the most experienced in the country. This translates to optimal chances for your successful recovery.
And because we are a major cancer research center, we are able to offer clinical trials of new treatments for some types of testicular cancer.
Our Testicular Cancer Treatments
If you are diagnosed with testicular cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.
One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Surgery
Orchiectomy: Surgery to remove the testicle. In most cases, orchiectomy is performed during testicular cancer diagnosis. The testicle is removed through an incision in the groin, and tissue samples are examined to determine the stage of the testicular cancer.
Retroperitoneal lymph node dissection (RPLND): For some patients, especially those with nonseminoma testicular cancer, surgery may also involve removal of lymph nodes in the abdominal area. This is done at the same time as the orchiectomy or in a second surgical procedure.
Nerve-sparing techniques: To preserve normal ejaculation, the surgeons at MD Anderson are skilled in surgical techniques that may avoid damage to the nerves surrounding retroperitoneal lymph nodes in some men.
Reconstructive surgery: Men who are uncomfortable with their appearance after orchiectomy can have a prosthesis implanted in the scrotum that provides the look and feel of a real testicle.
Possible side effects of testicular cancer surgery
If one testicle is removed to treat testicular cancer, most men can get erections and have sex if they are getting enough testosterone. If both testicles are removed, a man cannot father a child or make enough testosterone to have sex. In this case, testosterone needs to be taken in the form of a gel, patch or shot.
Because both surgical procedures may affect fertility, you may want to talk to your doctor about sperm banking if you want to start a family at some point. Sperm cells can be collected before cancer treatment and frozen for future use.
Radiation Therapy
Seminomas, which are the form of testicular cancer found most often, are very sensitive to radiation therapy. In fact, the treatment dosage is only about one-third of that required for prostate cancer, and the treatment cycle is only two weeks.
Radiation is performed after surgery to remove the testicle (orchiectomy). If the tumor was a seminoma, the oncologist may choose "watchful waiting" to see if the testicular cancer returns or use radiation to treat the lymph nodes along the spine, where the majority of recurrences are located.
Even if testicular cancer comes back, it is still treatable with radiation or chemotherapy. Radiation treatment has an average recurrence rate of about 5%. Radiation also can be used after chemotherapy if any cancer remains.
Other types of testicular cancer (nonseminoma) are more resistant to radiation. They are treated with orchiectomy, chemotherapy, and surgery to remove affected lymph nodes.
Chemotherapy
Chemotherapy is sometimes used in conjunction with surgical removal of the testicle to make sure all the cancer cells have been destroyed. For men with advanced tumors that have spread beyond the testicle or metastasized (spread) to distant areas of the body, chemotherapy is usually given for nine weeks or longer.
The most frequently used chemotherapy combinations for testicular cancer are:
- BEP: Blenoxane? (bleomycin), Etopophos? or Vepesid? (etoposide), and Platinol? (cisplatin)
- EP: Etopophos? or Vepesid? (etoposide) and Platinol? (cisplatin)
For men with poor-risk testicular cancer, MD Anderson uses an approach called dose-dense chemotherapy. A higher number of chemotherapy drugs are given at more-frequent intervals; this allows the cancer cells less time to recover between each treatment.
Stem Cell Transplantation
A stem cell transplant is used most often for testicular cancers that have returned after successful treatment. MD Anderson has one of the most-advanced stem cell transplant centers in the nation.
Our Testicular Cancer Clinical Trials
Since MD Anderson is one of the nation¡¯s leading research centers, we¡¯re able to offer a number of clinical trials (research studies) of new treatments for testicular cancer.
Learn more about testicular cancer:
Understanding orchiectomies: What you need to know
Orchiectomy ¡ª also known as orchidectomy ¡ª is the scientific term for the surgical removal of a testicle. It is usually performed to treat and confirm a diagnosis of testicular cancer, though it may be done for other reasons.
If you¡¯ve been told that you need this procedure, you might have some concerns. Does an orchiectomy hurt? How will it change the way your body looks and functions? Will you still be able to have sex and father children?
Here is what I tell my patients about orchiectomies.
Orchiectomies are simple, outpatient procedures
You might think that an orchiectomy is a major surgery?since an organ is being removed from your body. But it¡¯s actually a very simple procedure. It can generally be completed in less than 30 minutes.
You might also think that an orchiectomy requires cutting into the scrotum itself. Again, you¡¯d be mistaken. Surgeons usually make a small incision in the groin area, similar to the type made during an inguinal hernia repair. They remove the testicle and spermatic cord through that opening. No drains are placed and skin sutures will disappear on their own, with time.
Orchiectomies are normally performed on an outpatient basis. That means you can go home on the same day you have one. But you won¡¯t be able to drive yourself, because you¡¯ll be given some combination of local and general anesthesia to keep you comfortable both during and after the procedure.??
Differences in function after an orchiectomy
How an orchiectomy affects you will depend on several factors, including whether your second testicle is still present and healthy.??
You might not notice much difference in the way your body functions, for instance, if you:
- Are already infertile?
- Have low testosterone levels
- Are finished having children?
But since most of our testicular cancer patients are still fairly young, we offer them a referral to a fertility specialist before surgery. That way, they can get a baseline on their status and function and consider banking sperm. This is especially important if they¡¯ll need additional treatments afterward because chemotherapy in particular can cause infertility.
But an orchiectomy should not affect your sex life. You can still get an erection after an orchiectomy.
Differences in appearance after an orchiectomy
After an orchiectomy, your scrotum may look empty on the side that had the testicle removed. But it¡¯s usually not very noticeable, especially if you still have your other testicle.?
We do offer testicular prostheses, though, for patients who want them. These purely cosmetic devices are very similar to breast implants. They¡¯re made out of a silicone shell and filled with a saline solution. We install them during the same surgery, right after the orchiectomy. It only adds a few minutes to the procedure. They can make the scrotum look almost the same way it did before surgery.
Some other conditions might require an orchiectomy
Some non-cancerous conditions can also lead to an orchiectomy. These include:
- Torsion: when the spermatic cord twists around itself, cutting off a testicle¡¯s blood supply
- Trauma: any injury that shatters or ruptures a testicle
- Infection: especially a severe one that is not responding to antibiotics
Orchiectomies can also sometimes be used as a form of surgical castration to treat metastatic prostate cancer. But that only occurs in areas where hormone therapy is not consistently available. None of those are situations we typically deal with here.
A couple of non-cancerous conditions can also be confused with testicular cancer, but they don¡¯t require an orchiectomy. These are:
- Hydrocele: scrotal swelling caused by fluid around the testicle; usually seen in children or the elderly
- Varicocele: enlargement of the veins around the testicle that can cause infertility?
Orchiectomies can be both diagnostic and curative
When someone has a testicular mass, we start their workup with a medical history, physical examination, scrotal ultrasound and blood work to check for tumor markers. In general, we consider a testicular mass cancerous until proven otherwise. That¡¯s because, in more than 95% of cases, it is. Usually, testicular masses turn out to be some form of testicular cancer. But in very, very rare cases, leukemia and lymphoma turn out to be the cause.
The good news is that testicular cancer is fairly rare. And, when found early, it¡¯s often curable with just an orchiectomy. According to the American Cancer Society, of the almost 10,000 people diagnosed with testicular cancer each year, only about 500 ¡ª or less than 5% of them ¡ª will die from it.
Unlike many other cancers, testicular cancer is also found most frequently among people in their late teens, 20s and 30s. It can happen later in life, but that¡¯s pretty uncommon. Testicular cancer typically grows very fast, too. So, if you notice a mass in your scrotum, don¡¯t ignore it or wait for it to go away. Get checked out immediately.
is a urologic surgeon who specializes in kidney and testicular cancers.?
or call 1-877-632-6789.
How a testicular cancer diagnosis changed my life
Before I had testicular cancer, I was a really cynical person. I looked at the glass as half-empty. And I saw everything in life as just a struggle to get through.
I¡¯m not going to say that everything has a purpose now, but even the terrible things in our lives can be used for good. And looking back, I can see that a lot of good things did come out of having testicular cancer.
After I was diagnosed, I learned how to be grateful: for the small things and the big things, the bad things and the good things. And I think I am a more positive person now because of what I went through.
Choosing to live after my testicular cancer diagnosis
My testicular cancer journey started in late 2013, when I was 23. I had just come back from an extended trip to Taiwan. The plan was to finish my last semester at the University of Houston, where I was studying business.
But a few months after I arrived home, I noticed a lump on my left testicle. I had a fever, too. Immediately, my mind jumped to cancer, but I dismissed it as paranoia. Then I wondered, could this be the mumps? So, I went to my doctor. He didn¡¯t think the lump was related to the fever. And he wanted me to have an ultrasound.
The test was kind of awkward, but it didn¡¯t last very long. I got a call early the next morning. I needed to follow up with a urologist. I tried not to worry.
I met with that doctor a few days later and learned that I had testicular cancer. Time kind of froze when I heard the news. It just felt unreal. But the moment went on. And I realized I had a decision to make. I could either really freak out, or I could get this taken care of. I decided I wanted to live.
Why I chose MD Anderson for my testicular cancer treatment
There was no doubt in my mind that I wanted to go to MD Anderson for my testicular cancer treatment. While my particular type of testicular cancer is very treatable, it¡¯s also very aggressive. So I needed to take it seriously, and MD Anderson is a top-ranked cancer center with doctors who specialize in my exact type of cancer.
At MD Anderson, I met with He performed a bunch of tests and gave me a formal diagnosis: I had a stage IIB metastatic mixed nonseminomatous germ cell tumor, a type of testicular cancer.
As a part of my treatment, I had two surgeries: one to remove the tumor and my left testicle on June 3, 2013, and the other to remove my left spermatic cord and some lymph nodes on Nov. 13, 2013. In between, I had three rounds of chemotherapy, using a combination of bleomycin, etoposide and cisplatin.
Facing my fears
Coming to MD Anderson for chemotherapy was a really big feat for me. Up until then, I¡¯d had a great phobia of hospitals.
But chemotherapy wasn¡¯t as bad as I had feared. Don¡¯t get me wrong. It was still terrible. But it wasn¡¯t the monster I had created it to be in my head.
Each time I received chemotherapy, I was in the hospital for five days. I experienced nausea and total hair loss. But I had many people there to support me. I also had hope. And hope¡¯s contagious, I think.
Focusing on survivorship
Today, I am three years out from my testicular cancer diagnosis. I show no evidence of disease. So now, my focus is on survivorship.
It¡¯s not that my fear of recurrence is completely gone. But I¡¯m choosing to plan as if I¡¯m going to live a long time. I¡¯m transitioning to a new career and going back to the gym. I¡¯m doing all of these things not to get back to where I was, but to live the best life I can now.
If I had to go back and do it all over again, I would choose not to have cancer. But life doesn¡¯t work that way. The reality is that I had cancer and went through treatment. And I¡¯m grateful that I went through those things because I¡¯m now a more compassionate person with a greater ability to love.
I guess sometimes you have to be dying to realize how to live.
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