tESTICULAR CANCER TREATMENT
Stages
Treatments may vary depending on your Doctor or new trail drugs
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Treatment depends on what type of testicular cancer you have and what stage.
Staging in recent years can get very complicated in testicular cancer but to simplify it we stick to the older way.
Stage 1 - Confined to the testicle or confined to the testicle with an invasion of the vascular system (bloodstream)
Stage 2 - cancer has shown signs of spread to the lymph nodes in the tummy area. Your doctor might say tumours in the tummy. This is not stomach cancer it is tumours in the nodes near or behind the tummy and is secondary tumours.
Stage 3 - cancer has spread to the lymph nodes in the tummy area and in a major organ such as the lungs or in very rare cases the kidney or liver.
Stage 4 - cancer has spread to the lymph nodes and major organs such as some in the lungs and also the brain.
Again these tumours are not lung cancer or brain tumour but secondary tumours of testicular cancer.
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There is a more detailed look at testicular cancer staging here -
Treatments by stage
STAGE 1 with no signs of vascular invasion.
Seminomas tend to grow and spread more slowly and not show in the blood, although some seminomas can grow very rapidly and some can raise certain blood makers. A vast amount of seminomas are found early (stage 1) and just removing the testicle is all that is needed. The follow up will include more CT scans, blood tests and can cause you to be anxious. There is not a man alive who has gone through testicular cancer who does not get nervous before check-ups and test results.
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Most oncologists decide on how often they would want you to go in and have your check-up and scans BUT be sure that if there is any recurrence they will find it and start further treatment. Stage 1 follow-ups can spread over 5 years before your oncologist decides to stop seeing you and feel confident that it will not return, some oncologists might want to see you for ten years, again different Oncologists use different methods.
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STAGE 1 with vascular invasion.
If your pathology report says the cancer is confined to the testicle but has shown that it has invaded the bloodstream, BUT your CT scan is clear they may offer you preventative chemo called Carboplatin. First used in 1986, it can kill any rogue seminoma cells hiding in the lymphatic system. Figures vary but it's said to reduce the chances of it coming back from 20 percent to around 5 per cent.
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They may suggest you have 1 to 3 amounts of carboplatin. It is being used a lot more in recent years.
Carboplatin is administered by a drip over a few hours in the treatment or day ward. The advantage of carboplatin is that it was designed to have minimal side effects and not cause any long term damage that other testicular cancer regimes have.
Most men feel over the next 2 to 7 days like they have a flu bug or are hungover. They do feel that within 14 days they feel back to normal. It is important that you report any sickness or fever to the ward after you leave. On the whole, most men get through it fine.
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STAGE 2 cancer has spread to the lymph nodes.
Lymph nodes behind the tummy area are normally under 1 cm in size. If one or more are showing over 1 cm on your ct scan they will probably look at giving you 3 rounds of BEP or 4 rounds of EP chemo.
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In recent years some oncologists are trying 3 to 4 rounds of Carboplatin if there is a single tumor under 3 cm
If there is 1 node that is borderline abnormal ( 1 cm ) they may offer you radiotherapy on the lymph node area. Radiotherapy is getting used a lot less these days as unlike chemo it can only target one area. Chemo can get through the body in case anything is hiding.
There are new types of chemo being used these days due to research but it's more than likely that at present these treatments are used.
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STAGE 3 cancer has spread to lymph nodes behind the tummy and into the lungs.
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It is almost certain that 3 rounds of BEP or 4 rounds of EP will be administered. There are more details on chemo in the chemo section.
Seminoma has no stage 4 as it is extremely rare to go to other organs and the brain.
Seminoma has a very very high survival rate, over 95 per cent of men including stage 3 show no signs of cancer after this treatment.
Seminoma is seldom removed by surgery unlike some other types of testicular cancer.
Seminoma
non seminoma
Non-seminoma can be the more aggressive type of Testicular cancer and is mostly found in younger men under 35, but the survival rate is still very high at around 95 percent.
Non-seminoma is a tumour that is not 100 per cent pure seminoma and could have a mixture of the other types which include
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Embryonal carcinoma: present in about 40 per cent of tumours and among the most rapidly growing and potentially aggressive tumour types. Embryonal carcinoma can secrete HCG or alpha-fetoprotein (AFP) in blood tests.
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Yolk sac carcinoma: the most common type of tumour in children; responds well to chemotherapy in children and adults. Yolk sac tumours almost always secrete AFP blood markers
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Choriocarcinoma: a very rare and very aggressive form of testis cancer. Can secrete HCG in blood tests.
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Teratoma: most often appear as a mixed tumour that usually grows locally but can appear in retroperitoneal lymph nodes (behind the tummy). Teratoma is chemotherapy- and radiation-resistant and best treated with surgical removal. If you have a teratoma with a mix of other on seminoma types, they may give you chemo to stop these and then remove the teratoma with surgery.
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Your oncologist will use their experience to decide which would have the best results for the type of non-seminoma. We will describe the most common type of treatment but it may vary.
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Stage 1 non-seminoma
Stage 1 means that the cancer is confined to the testicle and there is no evidence of spread from your blood tests and scans. However, despite this, there is a risk that the cancer is still present in very small amounts. This can come back to other areas of the body.
Non-seminomas tend to produce three main types of tumour markers in blood tests, although in some cases they do not, The three main markers are:
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AFP (alpha-fetoprotein)
βHCG (beta-human chorionic gonadotropin)
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LDH (lactate dehydrogenase)
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In non-seminoma blood tests can really help with diagnosis. If one or more of these levels are above the normal range but return to normal after removing the testicle it's a good sign that you may have caught cancer early.
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They may offer you surveillance which is to not have any further treatment and keep a close eye on you which is normally monthly blood tests and check-ups for the first year, with a ct scan, every 2 months in the second year and then every 3 months in the third. After that every six months for another 2/3 years depending on which Oncologist you are under.
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If you had raised blood markers that came down to the normal range this is helpful because if there are signs of the cancer being back they may find this in the blood tests.
Stage 1 non-seminoma that has invaded the bloodstream (vascular invasion)
If your CT scan is clear but the report on your testicle shows the tumour had invaded the bloodstream then In recent years with this diagnosis Oncologists have opted for 1 dose of BEP or EP chemotherapy or surveillance. They will sit you down and explain the pros and cons of both.
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BEP chemo is
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Bleomycin
Etoposide
Cisplatin
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EP chemo is
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Etoposide
Cisplatin
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EP is basically BEP without Bleomycin and may be given if the man is over 40, a smoker or has a reaction to the BEP chemo. Bleomycin can cause lung damage and allergic reactions, on some occasions EP is then used.
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One dose could mop up cancer cells hiding and if there is a recurrence in the future then you can have more chemo to treat it.
STAGE 2 NON-SEMINOMA
If your CT scan shows enlarged lymph nodes, usually in the tummy area and higher tumour blood markers then you are all most certain to have 3 rounds of BEP chemotherapy unless there are circumstances that may call for 4 rounds of EP as mentioned above.
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After a kidney function test, You will be given BEP in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. You will be given extra fluids through a drip before and after cisplatin chemotherapy.
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Each round will be 3 to 4 days in hospital on a chemo drip, in recent years some hospitals offer day treatments where you return the next day for 3/4 days, but in our opinion, its safer to stay in hospital as it saves travelling and also if you get an infection you are in the best place to be seen by a doctor. Discuss this with your Oncologist.
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Once you have done this you will have to return in the next 2 weeks for a booster which should only take one day.
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Once you have completed this course your oncologist will want to see you once a month for a year for blood tests and a check-up but this may vary depending on your Oncologist as some do things a bit different from another. In the vast majority of cases, this is successful.
Stage 3 and 4 non-seminoma
If your scan has signs of tumours in lymph nodes and tumours in the lungs brother parts of the body then a full amount of chemo is needed. The treatment for non-seminoma stages 3 and 4 is possibly 3 or 4 rounds of BEP or EP. This could take up to 8 weeks to complete.
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Bep Chemo is very good in treating non-seminoma even in the later stages, although it can be a pretty hard and bumpy ride going through this chemo it is needed and within the time you will have finished and been on the mend.
TIP CHEMO
MORE CHEMO?, yes sometimes after BEP chemo you may need more as BEP has done well but just a bit more is needed. This is might be called TIP chemotherapy and is sometimes used just to carry on getting that little bit extra cancer. Tip is a combination of
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paclitaxel (Taxol)
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ifosfamide
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cisplatin (platinum)
Its used also if cancer returns pretty soon after the first treatments or the first chemotherapy treatments has not done enough to get rid of the tumors.
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Usually, the TIP chemotherapy is given as a cycle of treatment. This means that you have the drug and then rest to allow your body to recover. Each cycle of treatment lasts 21 days (3 weeks). You have 4 to 6 cycles.
The 3 weak cycle is usually 1 week in hospital with the next 2 of recovery.
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If you do have to have TIP then yes it again is tough but it still has a good chance of helping get rig of cancer.
See our tips on chemo page
Retroperitoneal lymph node dissection (RPLND)
Some men who've been treated for non-seminoma have to have an operation called "Retroperitoneal lymph node dissection (RPLND)". This op is to remove certain types of tumours that can more commonly flare up again after chemo. In most cases when this is needed it's to remove lymph nodes that were shown to be cancerous. Your oncologist will explain why.
They go in through and behind your tummy and take them out. It is a major operation and can take many hours to do BUT in our experience, almost all men get through it fine, it can take a bit of time to recover and you will need to rest and take care not to over to the tummy area muscles but the lads on our forum are often proud to show off the scar and joke about it.
Of course, any operation has risks, and in some cases, it can cause fertility problems and ejaculation problems and your doctor will help with this but in most cases, everything works fine after.
