Testicular Cancer Treatments
Personalized treatment for testicular cancer means your unique needs are our priority.
Our approach to treating testicular cancer involves deep analysis, advanced technology, and a team of expert urologists, oncologists, and surgeons. This team and other specialists are part of our tumor board. They will evaluate the stage of testicular cancer, your health, and your unique needs before they create a tailored treatment plan. It may include:
Before any treatment begins, you can discuss options for preserving fertility. Treatment for testicular cancer can disrupt fertility, and we advise teenage boys and men to discuss sperm banking. In a supportive environment, our fertility consultants will be available to answer your questions within 24 hours.
Our tumor board will carefully evaluate your condition and determine the best approach to your treatment. These are some options they may discuss with you.
Advanced and minimally invasive surgery
For nearly all types and stages of testicular cancer, doctors recommend surgery to remove the affected testicle and any cancer from surrounding tissue and lymph nodes. At Henry Ford, our highly skilled surgeons have the knowledge and experience required to perform this delicate and challenging surgery. Whenever possible, they make small incisions, instead of large ones. Our patients benefit from reduced blood loss, less discomfort, and fewer complications. Men can return to their normal activities sooner because their hospital stays are shorter.
- Laparoscopic radical inguinal orchiectomy involves making tiny incisions in the scrotum and carefully removing the cancerous testicle through the scrotum. This surgery may be done on an outpatient basis, and it may be the only treatment needed for men in the early stage of testicle cancer. Some men choose to have a prosthetic, saline-filled testicle inserted at the time of surgery. Others may have it done later.
- Radical inguinal orchiectomy involves making a small incision in the groin. The testicle is pushed upward from the groin and out through the incision. This surgery may be the only treatment needed for men in the early stage of testicle cancer. The procedure can be done on an outpatient basis. Some men choose to have a prosthetic, saline-filled testicle inserted at the time of surgery. Others may have it done later.
- Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is a minimally invasive procedure that involves making several small incisions, rather than one long one, to remove the lymph nodes near the lower back, pelvis, or testicles. To determine if these nodes are swollen, you will have a CT scan of the pelvic area and abdomen. The surgery may be done at the time the orchiectomy is performed or as a second surgery. Because the incisions are small, patients experience less discomfort and a faster recovery time than with traditional open surgery. Special nerve-sparing techniques are used during the surgery to protect the nerves involved in ejaculation.
- Retroperitoneal lymph node dissection (RPLND) is a surgery that may be done at the time the orchiectomy is done or as a second surgery. RPLND involves removing the lymph nodes near the testicles, lower back, or pelvis. Generally, these lymph nodes cannot be felt or noticed when they swell. Your doctor will determine if the lymph nodes are enlarged by doing a CT scan of the abdomen and pelvis. Surgery is done by making an incision from the sternum to the area below the navel to remove the diseased nodes. To protect the nerves involved in ejaculation, special nerve-sparing techniques are used by our surgeons.
When testicular cancer has spread, or metastasized, radiation therapy may be used. It may also be used to destroy any cancer cells that remain after surgery. Radiation therapy damages the DNA of cancer cells so the cells stop growing and die. However, it may take weeks of treatment before the cancer cells begin dying. After radiation ends, the cancer cells may continue dying for months. The dead cells are broken down and eliminated from the body.
Henry Ford is a world leader in new approaches to radiation therapy and the fast-developing field of radiosurgery, a type of radiation that uses precise, advanced technology to deliver higher doses of radiation in fewer sessions. Our options for radiation therapy for testicular cancer include:
- MRI-guided radiation therapy, known as ViewRay MRIdian Linac, may be an option for select patients. This technology provides precise and accurate radiation treatment. To help protect healthy tissue near cancer cells, imaging is done at the same time radiation treatment is done. This allows physicians to accurately target the cancer cells and use a strong dose of radiation to kill the cancer.
- External beam radiation therapy (EBRT) involves using high-energy rays to kill testicular cancer. The rays are similar to X-rays, and the painless treatment is often used for low-grade cancer.
- Three-dimension conformal radiation therapy (3D-CAT) uses special computers to find the precise location of the cancer. From several directions, the radiation beams are aimed at the cancer, making it less likely to damage normal, surrounding tissue.
- Intensity modulated radiation therapy (IMRT) involves using a machine that moves and delivers radiation to the area affected by cancer. To allow the doctor to provide higher doses of radiation, the beams are shaped and precisely aimed.
- Image-guided radiation therapy (IGRT) allows the doctor to take images of the areas affected by cancer and adjust the aim of the radiation beams immediately before delivering treatment.
- Stereotactic body radiation therapy (SBRT) involves delivering a large dose of radiation to precisely obliterate cancer cells. The treatment may be completed in a few days, but the side effects may be greater than with IGRT.
When both testicles have been removed, or they are not functioning normally, testosterone will not be produced. To reduce or prevent side effects from the loss of testosterone, hormone therapy may be given. The side effects may include loss of sexual interest, erectile dysfunction, weight gain, muscle loss, osteoporosis, and breast enlargement.
Chemotherapy uses drugs to damage or destroy cancer cells at certain stages of the disease. Our testicular cancer team includes physicians called medical oncologists who specialize in the administration of chemotherapy. They will customize the best treatment, which may include:
- Adjuvant chemotherapy is often given after surgery. This chemotherapy is used to kill any remaining cancer cells that may have spread or were not seen during surgery. In many cases, it can reduce the risk of new cancerous tumors.
- Neoadjuvant chemotherapy may be given before surgery in some cases. Neoadjuvant chemotherapy may decrease the risk of the cancer returning, and it can kill cancer cells that are unseen because they have moved away from the original tumor site.
After surgery to remove Stage 1 testicular cancer that was slow-growing, your doctor may recommend active surveillance. This approach may reduce the need for chemotherapy or radiation therapy. Active surveillance involves closely monitoring signs or symptoms to determine if the cancer has returned. Usually, surveillance lasts for 5-10 years, depending on your condition and your doctor’s advice. For the first three years, follow-up visits with your doctor may be required every 2-6 months, and then they will be reduced. Tests done during the visits may include a physical exam, blood tests, chest X-ray, or CT scan of the abdomen.
Treatment for testicular cancer can cause infertility. Before any cancer treatment begins, talk with your doctor about your options for preserving fertility. They may include:
- Radiation shielding involves using a lead shield to protect the testicles from the scattering X-rays during radiation treatment. After treatment, unprotected sexual activity should be avoided for a period of time.
- Sperm banking involves collecting semen by masturbation, by help from a partner’s stimulation, or by a vibratory stimulation device. Within one hour, semen is taken to a sperm bank where estimates will be made of the sperm-cell count, normal-shaped sperm, and sperm motility. Cells are frozen and stored until needed.
Medical research, known as clinical trials, is constantly being done to find better ways of treating testicular cancer. Enrolling in a clinical trial may provide treatment options that are still under exploration. At Henry Ford, our research nurse will work with you to find the clinical trial for a new drug or treatment approach that meets your needs.
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