Testicular Cancer Treatment
Treatment for testicular cancer will almost always involve a radical inguinal orchiectomy. This serves as the initial diagnostic test that will dictate further therapy if needed. The procedure is a surgery during which the affected testicle will be removed. This is done as an outpatient procedure. At the same time a testicular prosthesis can be placed on an elective basis. The vast majority of testicular tumors represent germ cell tumors. This consists of 2 categories: seminoma and non-seminoma. However, no one treatment will meet the challenge presented by the various testicular cancers. The two types of testicular tumors are equally curable, however, they can require different treatment algorithms.
Seminomas that are stage one often require radiation therapy to the retroperitoneum. As seminomas become more advanced, chemotherapy may be indicated. The two chemotherapeutic agents used in this case are etoposide and cisplatin. None-seminomatous germ cell tumors (NSGCT) can be treated with active surveillance after the initial orchiectomy in select, good-risk situations. In a few cases, depending on the type and the stage of your cancer, your surgeon may also choose remove the lymph nodes from behind the abdomen with a surgical procedure known as a retroperitoneal lymph node dissection. This procedure is traditionally performed via a midline open surgical incision. This may also be combined with chemotherapy depending upon the stage of the tumor.
Many Testicular Cancer Patients Worry About Fertility
The open surgical removal of lymph nodes from the back of the abdomen has been known to cause damage to the nerves in the area, the nerves responsible for ejaculation. This obviously carries the risk of post-operative infertility in that it can prevent the normal ability to ejaculate. Modern surgical techniques have now been refined to a point where the sympathetic nerves that cause ejaculation can be prospectively identified and preserved. In doing so, ejaculation can be preserved in over 98% of patients. Dr. Scherr recommends sperm donation prior to embarking upon treatment for testicular cancer to maximize the likelihood of fertility post-treatment.
Initially, all surgical patients will be required to have the affected testicle removed (the inguinal orchiectomy noted above). This tends to provoke concerns focused on fertility and sexuality. Men with testicular cancer occasionally experience problems related to fertility before diagnosis, which may or may not improve after surgery, regardless of the technique employed. Both chemotherapy and radiation treatments may also have an affect on sperm production or ejaculation. However, a single testicle can produce the hormones and sperm to maintain an erection or father a child. Every effort toward nerve sparing should be made.
Treatment May Include a Combination of Surgery, Radiation and Chemotherapy
Because they tend to grow slowly and stay localized, seminomas (non-hormonally active testicular tumors) are generally diagnosed during stage one or by stage two. Therefore, your treatment may be a combination of testicle removal (orchiectomy), radiation therapy or chemotherapy. However, because seminomas tend to be sensitive to radiation, the surgery to remove lymph nodes usually isn't necessary. Radiation can effectively remove seminoma cells found in retroperitoneal lymph nodes. Even stage three seminomas are typically treated with multi-drug chemotherapy.
Despite the fact that most non-seminomas aren't diagnosed during their early stages, cases confined to the testes often require no treatment other than surgical removal. Such patients have to follow-up carefully for at least two years. Stage two non-seminoma patients who have had a testicle and lymph nodes surgically removed might not need any follow-up therapy either. Dr. Scherr typically recommends a short course of multi-drug chemotherapy if his patients are stage two to reduce the risk of recurrence. Often, stage three non-seminomas can be cured using a combination of drugs.
Some Patients Do Have to Stay Overnight but Most Go Home the Same Day
The actual orchiectomy will involve incisions along the so-called "bikini line" via the lower abdomen, and will not include a cut-in through the scrotal sack, as many assume. Once the incisions have been made, the afflicted testicle will be pushed up through the pelvic region and out. On average, orchiectomy takes between forty-five minutes and one hour. Based on Dr. Scherr's experience, most patients can go home the same day of surgery.
You'll also need to remember to make a follow-up appointment to see your urologist within ten to fourteen days of your discharge. Thereafter you should follow-up on a schedule of three months, six months, one year, a year and a half and so on for at least five years but often for life. Tests including chest X-ray films, blood tests and abdominal CT scans should be arranged as needed.
If you'd like additional information about testicular cancer, its diagnosis and care or any advice you may need concerning complementary treatment methods, please don't hesitate to contact our office.