Testicular Cancer

Treatment

Patients with testicular cancer can be treated at Mayo Clinic with the latest advances in surgery, chemotherapy and, in some cases, radiation therapy. Other innovative treatments may also be available. One method or a combination of methods may be used depending on the type and the stage of the cancer, age and overall health.

Surgery

As part of the diagnostic process many patients undergo radical inguinal orchiectomy. During this procedure a surgeon will remove the testicle through an incision in the groin. A pathologist will then examine the tissue under a microscope. Patients who are concerned about changes to the physical appearance of the genitals may choose to have an artificial testicle (prosthesis) implanted inside the scrotum. For patients whose cancer has spread beyond the testicles, additional surgery, chemotherapy and/or radiation may be necessary.

Chemotherapy

Testicular cancer usually responds positively to chemotherapy. This treatment kills cancer cells that have spread beyond the testicle to other parts of the body. Patients typically receive intravenous infusions of the chemotherapy drugs. In some cases, chemotherapy may be given by intramuscular injection. Chemotherapy for 9 to 12 weeks may be needed for stage II or III seminomas that are bulky (larger than 6 cm) or multifocal. At completion of the drug regimen, surgery or radiation may be required to remove residual tumor masses.

Radiation Therapy

In radiation therapy, high-dose X-rays or other high-energy radiation kill cancer cells. Patients with seminoma cancer typically respond well to radiation therapy. The therapy is infrequently used for nonseminoma cancer other than to alleviate symptoms from cancer that has spread to other parts of the body and become unresponsive to chemotherapy.

Retroperitoneal Surgery

This type of surgery can be very difficult and requires the skills of experienced surgeons. Urologic surgeons at Mayo Clinic have had extensive experience performing this procedure. During retroperitoneal surgery, experts remove lymph nodes in the abdomen that have potentially been infiltrated by the testicular cancer.

Effects of Testicular Cancer Treatment

People with testicular cancer often wonder how treatment will affect their appearance and sex life. Some things to keep in mind include:

• Removal of one testicle does not necessarily make a man sterile or interfere with the ability to have sexual intercourse. The remaining healthy testicle can maintain normal sexual and hormonal functions. An artificial testicle (prosthesis) can be implanted into the scrotum so the appearance is normal. However, men who have had testicular tumors generally have lower fertility rates than other males.
• Removal of the retroperitoneal lymph nodes will not affect the ability to achieve an erection or an orgasm. However, this surgery may cause sterility by interfering with ejaculation, depending on the location and number of lymph nodes removed. Some men recover the ability to ejaculate without treatment, and medication may help others. Newer nerve-sparing surgical techniques can decrease the likelihood of postoperative ejaculatory problems following surgery.
• Chemotherapy does not have to interfere with a normal sex life. The fatigue caused by chemotherapy, however, may decrease interest in sexual activity during the months of treatment. Some anticancer drugs affect sperm production. Although the effect can be permanent, many men regain their fertility. Men concerned about fertility can have their sperm frozen and preserved prior to chemotherapy.
• Radiation typically does not change the ability to have sex. However, radiation does interfere with sperm production. The effect is usually temporary, and most men regain their fertility within a few months. As a precaution, many men store sperm at a special facility or "bank" before treatment, where it can be preserved for later use.