The first treatment for localized, early-stage seminomas and nonseminomas is usually surgery to remove the affected testicle. For more advanced tumors, additional surgery, chemotherapy, or both may be required.
Surgery to remove a testicular tumor and the affected testicle is called a radical orchiectomy. Although radical orchiectomy is usually performed during diagnosis and staging, it is also a highly effective treatment. In fact, radical orchiectomy, combined with lifelong surveillance, may be the only treatment needed for men with an early-stage germ cell tumor that has not spread from the testicle.
Radical orchiectomy will not affect your fertility or ability to achieve and sustain an erection. Some men choose to have a prosthetic testicle inserted during surgery for cosmetic purposes.
If pathology tests suggest that the tumor is likely to metastasize or has already spread to lymph nodes in the abdomen, our physicians may recommend additional surgery to remove lymph nodes in the area behind your abdominal organs. This operation, called a retroperitoneal lymph node dissection (RPLND), can help doctors definitively determine if the cancer has spread, remove any cancer that is found in the lymph nodes, and make additional treatment recommendations.
RPLND does not affect the ability to have a normal erection. However, when this procedure is used to treat very large tumors in the lymph nodes or abdomen, it can cause a complication called retrograde ejaculation, in which semen travels backward into the bladder instead of into the urethra during ejaculation.
Our surgeons have extensive experience using a nerve-sparing technique that allows them to remove enough lymph nodes surrounding the tumor to decrease the risk that the cancer will spread, while preserving normal ejaculation and fertility.
Radical orchiectomy combined with RPLND can cure many early-stage nonseminomas. Doctors at Memorial Sloan Kettering have shown that RPLND after chemotherapy is also effective in preventing tumors from returning in most men with advanced testicular cancer.(1)
Chemotherapy is a systemic treatment that kills cancer cells nearly everywhere in the body. At Memorial Sloan Kettering, chemotherapy is usually reserved for men with testicular cancer that is more advanced or is likely to spread, based on diagnostic and laboratory tests.
Chemotherapy is often very effective in eliminating or preventing the recurrence of advanced seminoma and nonseminoma tumors that have spread beyond the testicle. Overall survival for men with advanced testicular cancer who are treated with chemotherapy is greater than 70 percent.(2)
Our medical oncologists use a variety of chemotherapy drugs, depending on the stage of your cancer. Most of the chemotherapy regimens used to treat testicular cancer were developed and refined at Memorial Sloan Kettering.
A common initial chemotherapy regimen for men with advanced testicular cancer is called EP, which is a combination of the drugs etoposide and Platinol® (cisplatin). Another chemotherapy drug, called bleomycin, may be given in addition to EP to treat tumors that have a higher risk of spreading.
A different chemotherapy regimen may benefit men who have testicular cancer that has returned after an initial round of chemotherapy. A combination of drugs known as TIP – Taxol®, ifosfamide, and Platinol® — has been shown to cure many men who have recurrent testicular cancer.(3) Doctors at Memorial Sloan Kettering are also evaluating the safety and effectiveness of TIP as an initial treatment for men with advanced testicular cancer who have a higher risk of recurrence.
For men with testicular cancer that does not respond to other chemotherapy regimens, our treatment team has developed(4) a high-dose chemotherapy regimen that combines Taxol®, ifosfamide, carboplatin, and etoposide (TICE). Like standard-dose chemotherapy regimens, high-dose chemotherapy can damage blood-forming cells in the bone marrow. However, recovery from high-dose chemotherapy can take much longer than recovery from standard doses.
To help speed the blood’s recovery, we collect the patient’s own blood cells, also called stem cells, prior to treatment with TICE. After chemotherapy, these stem cells are reinfused into the patient’s blood, where they begin producing new blood cells. Learn more about stem cell transplantation at Memorial Sloan Kettering.
Because surgery and chemotherapy are quite effective for treating testicular cancer, radiation therapy is no longer commonly used to treat this disease. However, in some cases, our doctors may recommend external-beam radiation therapy, which destroys cancer cells with radiation energy delivered to the affected area by a machine, following radical orchiectomy for large seminoma tumors or tumors that have spread beyond the testicle.
After testicular cancer, lifelong surveillance is crucial. Your doctor may examine the unaffected testicle for any lumps or abnormalities during follow-up physical examinations. You should also perform self-examinations at home to detect any sign of recurrence. Blood tests to look for tumor markers will also be performed during your physical exams, which may be helpful in identifying a tumor that has returned.