Newly Diagnosed?
We Can Help Getting the correct diagnosis and the most appropriate treatment from the start is crucial 
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Advances in the treatment of testicular cancer in the last 30 years have led to significant improvements in survival. Studies have shown that up to 90 percent of testicular cancers can be cured, especially if the tumor is found early, the patient has a favorable prognosis, and is treated in an appropriate and timely manner.1
Although testicular cancer is often curable, it is still very serious. The disease can progress from stage I, localized cancer in the testicle, to stage III, where cancer has spread to distant parts of the body, in just a few months.
Treatment of testicular cancer depends on the type of tumor found (seminoma or nonseminoma) and the stage of disease -- the size of the tumor, lymph node involvement, whether the cancer has spread, and blood marker levels. Men with a testicular tumor may require surgery, radiation therapy, chemotherapy, surveillance, or a combination of these treatments.
Treatment of Seminoma Tumors
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Early-Stage Seminoma (Stages I-IIA)
For many patients with the earliest stage of testicular cancer, removing the testicle in a surgical procedure called radical orchiectomy combined with lifelong follow-up surveillance may be the only therapy needed. This procedure does not affect fertility or potency. However, some patients may choose to have a prosthesis inserted after surgery for cosmetic purposes. Adherence to follow-up surveillance is critical, as a low percentage (about 15 percent) of patients treated for early-stage seminoma will experience a relapse.
Additional treatment after orchiectomy depends on whether there is evidence that the cancer may have spread beyond the testicle and what type of tumor is found. Clinical data have demonstrated that external-beam radiation therapy administered to the abdominal and pelvic lymph nodes is highly effective for seminoma tumors that have not shown signs of spreading beyond the testicle, as seen on x-rays.2 Our doctors use CT (computed tomography) images of surrounding areas, such as the kidneys and bowel, to identify healthy tissue that should be protected during radiation therapy. The unaffected testicle is shielded from the radiation during treatment.
The vast majority of patients with early-stage seminoma tumors who receive radiation therapy following surgery will be cured.3 However, follow-up is required to manage the side effects of radiation therapy, which may include fatigue, skin changes at the treatment site, loss of appetite, nausea, diarrhea, and temporary problems with sperm production. Rarely, many years later, a new cancer may develop where the radiation was given.
In addition, patients with stage I seminoma often do not have elevated blood tumor markers, so ongoing surveillance after radiation therapy can help monitor patients for recurrence of tumors and secondary cancers.
Treatment of Nonseminoma Tumors
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Early-Stage Nonseminoma (Stages I-IIB)
Treatment of early-stage nonseminoma tumors begins with a radical orchiectomy to remove the affected testicle. If the pathologist does not find cancer cells inside the blood vessels of the testicle, follow-up surveillance will be recommended. If cancer cells are present in the blood vessels, additional surgery to remove lymph nodes from the retroperitoneum (the area of the abdomen behind the abdominal organs) may be necessary. This procedure, called retroperitoneal lymph node dissection (RPLND), is performed through an incision in the abdomen. Doctors at Memorial Sloan-Kettering have demonstrated that many patients with early-stage nonseminoma tumors may be treated successfully with RPLND, avoiding the side effects of chemotherapy.4 5
Occasionally, removal of lymph nodes from the back of the abdomen may cause damage to nerves that are responsible for ejaculation, which can result in infertility. Doctors at Memorial Sloan-Kettering have significant experience in performing a nerve-sparing surgery that has been shown to improve the chance of preserving these nerves and their function in approximately 95 percent of patients.6 In addition, this nerve-sparing technique allows surgeons to remove a wider safety margin of healthy tissue surrounding the tumor, decreasing the risk that cancer cells will spread to other areas of the body.7
Patients with stage I or II nonseminoma tumors may be treated with chemotherapy following surgery, particularly if their blood marker levels remain high.
Advanced Testicular Cancer (Stages IS, IIB to III)
Sidney Kimmel Center for Prostate & Urologic Cancers Our state-of-the-art
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Chemotherapy is a highly effective treatment for many patients with nonseminoma testicular tumors that have metastasized (spread) beyond the testicle to other regions of the body. The standard of care for patients with early-stage nonseminoma tumors includes treatment with the combination of etoposide and cisplatin (known as EP), or a combination of bleomycin, etoposide, and cisplatin (known as BEP). Overall survival among patients who receive this chemotherapy regimen is greater than 90 percent.8 Because of potential side effects such as cardiovascular problems, infertility, and secondary cancers, chemotherapy often is reserved for patients with later-stage disease.
Treatment with a combination of chemotherapy drugs, including paclitaxel, ifosfamide, and cisplatin (known as TIP) is often effective for many patients whose testicular cancers have returned after chemotherapy with EO or BEP. Memorial Sloan-Kettering is evaluating the safety and effectiveness of TIP therapy as an initial treatment for patients with advanced germ cell tumors.
Our doctors also have significant experience in treating patients with a high-dose chemotherapy regimen known as TICE (paclitaxel, ifosfamide, carboplatin, and etoposide) plus autologous stem cell transplant (a procedure in which the patient's own stem cells are collected before chemotherapy and returned to the patient after treatment). This regimen is reserved as a secondary treatment for patients whose disease initially responded to therapy but was not eradicated. (For more information, visit the Transplantation information on our Web site.)
Research at Memorial Sloan-Kettering has shown that retroperitoneal lymph node dissection (RPLND) following chemotherapy is highly effective in most patients with late-stage disease. In addition, using the nerve-sparing surgical technique has been shown to preserve normal ejaculation (also called antegrade ejaculation) in 80 percent of patients.9 Based on the research findings, our doctors have improved the selection process for which patients are most likely to benefit from this combination treatment to improve survival among patients with later-stage disease.10 11
Treatment and Fertility
Our Support Services We understand that life is different after a diagnosis of cancer
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Although potency is not usually impaired by testicular cancer treatment, fertility (the ability to produce viable sperm or achieve proper ejaculation) can be interrupted by surgery, chemotherapy, and radiation treatments. For this reason, Memorial Sloan-Kettering doctors recommend that patients who are planning to receive chemotherapy, radiation therapy, or undergo RPLND store their sperm before treatment begins. This sperm will be frozen and could be used later to conceive a child.
For information about follow-up care and support, visit that section of this cancer information overview.
1Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA. 2008 Feb 13;299(6):672-84. [PubMed Abstract]
2Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A, Stenning SP. Randomized trial of 30 versus 20 gy in the adjuvant treatment of stage I testicular seminoma: a report on medical research council trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942. J ClinOncol. 2005 Feb 20;23(6):1200-12. [PubMed Abstract]
3Fossa SD, Horwich A, Russell JM, Roberts JT, Cullen MH, Hodson NJ, Jones WG, Yosef H, Duchesne GM, Owen JR, Grosch EJ, Chetiyawardana AD, Reed NS, Widmer B, Stenning SP. Optimal planning target volume for stage I testicular seminoma: a Medical Research Council randomized trial. J ClinOncol. 1999 Apr;17(4):1146-54. [PubMed Abstract]
4Stephenson AJ, Bosl GJ, Motzer RJ, Bajorin DF, Stasi JP, Sheinfeld J. Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer. J ClinOncol. 2007 Dec 10;25(35):5597-602. [PubMed Abstract]
5Stephenson AJ, Bosl GJ, Bajorin DF, Stasi J, Motzer RJ, Sheinfeld J. Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion. J Urol. 2005 Aug;174(2):557-60; discussion 560. [PubMed Abstract]
6Carver VS, Sheinfeld J. Germ cell tumors of the testis. Ann SurgOncol. 2005 Nov;12(11):871-80. [PubMed Abstract]
7Eggener S, Carver BS, Sharp DS, Motzer RJ, Bosl GJ, Sheinfeld J. Incidence of disease outside modified retroperitoneal lymph node dissection templates in clinical stage I and IIA nonseminomatous germ cell testicular cancer. J Urol. 2007 Mar;177(3):937-42; discussion 942-3. [PubMed Abstract]
8Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA. 2008 Feb 13;299(6):672-84. [PubMed Abstract]
9Shayegan B, Carver BS, Stasi J, Motzer RJ, Bosl GJ, Sheinfeld J. Clinical outcome following post-chemotherapy retroperitoneal lymph node dissection in men with intermediate- and poor-risk nonseminomatous germ cell tumor. BJU Int. 2007 May;99(5):993-7. [PubMed Abstract]
10Carver BS, Bianco FJ Jr, Shayegan B, Vickers A, Motzer RJ, Bosl GJ, Sheinfeld J. Predicting teratoma in the retroperitoneum in men undergoing post-chemotherapy retroperitoneal lymph node dissection. J Urol. 2006 Jul;176(1):100-3. [PubMed Abstract]
11Carver BS, Shayegan B, Serio A, Motzer RJ, Bosl GJ, Sheinfeld J. Long-term clinical outcome after postchemotherapy retroperitoneal lymph node dissection in men with residual teratoma. JClin Oncol. 2007 Mar 20;25(9):1033-7. [PubMed Abstract]
Last Updated: Jun. 30, 2009
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