Testicular cancer treatment

The 3 main treatments for testicular cancer are:

• surgery
• chemotherapy     
• radiotherapy. 

You usually have surgery to diagnose and remove the cancer. This is called an orchidectomy. After this, your doctors and other members of the multidisciplinary team will talk to you about the treatment options. They will explain what might be best for your situation.

They may talk to you about surveillance. This is the option of monitoring you regularly in clinic. Or they may suggest having chemotherapy after surgery. Occasionally, they may suggest radiotherapy. Treatment options depend on:

• the stage of the cancer
• whether it is a non-seminoma or seminoma (see below)
• the risk of it coming back.

If testicular cancer comes back, it can usually be treated successfully.

If you are aged between 16 and 24, you should have the option of having your treatment at a Principal Treatment Centre (PTC). These centres provide cancer services for teenagers and young adults (TYA).

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.
• Visit our testicular cancer forum to talk with people who have been affected by testicular cancer, share your experience, and ask an expert your questions.

Stage 1 testicular cancer is cancer that has not spread outside the testicle.

Surgery to remove the testicle (orchidectomy) may be the only treatment you need.

After surgery, your doctor will ask you to go to the clinic for regular physical examinations and have blood tests, including a test to check your tumour marker levels. You may also have CT or MRI scans at the clinic. This is called monitoring (surveillance). If the cancer comes back, the surveillance tests help to find it at the earliest stage. Further treatment can usually cure the cancer.

Your doctor may offer you chemotherapy treatment after surgery. This is called adjuvant treatment. You have it to reduce the risk of the cancer coming back.

Your doctor will explain why they have suggested adjuvant treatment. After talking to your doctor, you may feel you do not want treatment that might not be necessary. You may decide not to have treatment, and to have surveillance instead.

And if you have the option of surveillance, you may decide to have chemotherapy treatment instead.

You can talk about the benefits and disadvantages of the treatment with your doctor.

If you have a stage 1 seminoma, your doctor may suggest you have surveillance (monitoring). This is if there is a low risk of the cancer coming back. You usually need to have regular clinic appointments for several years.

Your doctors may also offer you a single dose of adjuvant chemotherapy, with a drug called carboplatin.

Your doctors will decide whether you will benefit from adjuvant treatment based on:

• the size of the tumour
• how it looks under a microscope
• the tumour marker levels (if present).

If you have a stage 1 non-seminoma, your doctor may suggest you have surveillance if there is a low risk of the cancer coming back. After a few years, you may only need to have regular blood tests, if scans show no signs of the cancer.

Your doctors may also offer you the option of adjuvant treatment. The chemotherapy drugs usually used for non-seminoma testicular cancer are bleomycin, etoposide and cisplatin. This combination of chemotherapy drugs is also called BEP chemotherapy. You usually have 1 session of treatment.

Doctors will offer treatment depending on:

• how the cancer looks under a microscope
• if it has spread to nearby blood vessels
• the size of the tumour
• the tumour marker levels (if present).

If testicular cancer comes back, treatment can usually cure it. This is even if the cancer has spread to other parts of the body. Treatment will depend on the type of testicular cancer, the areas affected and previous treatment.

You may be offered some treatments as part of a clinical trial.

Current research

Although current treatments for testicular cancer are very effective, different trials are being carried out to see if there are ways to improve them. For example, trials are looking at which genes may increase the risk of developing testicular cancer. Your doctors will be able to tell you about any trials that may be suitable for you.

With early-stage testicular cancer, surgery alone may cure the cancer. Adjuvant chemotherapy may be offered to reduce the risk of the cancer coming back. Or your doctors may ask you to choose what you want to do. They may ask whether you want to have adjuvant treatment or surveillance. Sometimes people find it hard to make a decision like this.

You may be worried about having adjuvant treatment because it is treatment you may not need, and it has side effects. Or you may prefer to have any treatment that might reduce the risk of the cancer coming back.

You can talk about the benefits and disadvantages of treatment with your doctor. It is important that you have all the information you need to make the right choice for you. Your doctor and nurse will talk to you about:

• the risk of the cancer coming back
• the benefits and side effects of the treatment
• ways to cope with side effects.

If early-stage testicular cancer comes back, the aim of treatment is still usually to cure it.

If the cancer is very advanced or comes back after initial treatment, you may need intensive chemotherapy. But the aim will also usually still be to cure the cancer.

Rarely, very advanced testicular cancer may not respond well to treatment. Or it may continue to come back despite treatment. In this case, you can have treatment to help control the cancer and improve symptoms. Occasionally, the treatment may not control the cancer or improve symptoms. This means you would have side effects without the benefit of treatment. In this case, you may decide not to continue the treatment.

Making decisions about treatment can be difficult. You may need to talk about it with your doctor and family or friends. If you choose not to have treatment for the cancer, you can still have treatment to control any symptoms.

Giving your permission

Doctors need your permission (consent) before you have any treatment. They will give you all the information you need to make your decision. You will usually need to sign a form to say that you agree.

Second opinion

A second opinion is an opinion from a different doctor about your treatment. If you think you want a second opinion, talk to your specialist doctor or GP first. Tell them your concerns or ask them to explain anything you do not understand. If you still want a second opinion, you can ask your specialist doctor or GP to arrange it.