The doctor might recommend high-dose chemo followed by a stem cell transplant. Enrolling in a clinical trial of a newer chemo regimen might be another good option. If the cancer goes away with treatment and then comes back, it's said to have recurred or relapsed. Treatment of recurrent germ cell tumors depends on the initial treatment and where the cancer recurs.
Cancer that comes back in the retroperitoneal lymph nodes can be treated by surgery to remove the nodes RPLND if the recurrence is small and if the only surgical treatment given before was orchiectomy. Depending on the results of the surgery, chemo may be recommended as well. If it looks as if cancer has recurred in a lot of the retroperitoneal lymph nodes or if the cancer has returned elsewhere, chemo is usually recommended.
This may be followed by surgery. The treatment of testicular cancer that has come back after chemo is not always as effective as doctors would like, so some doctors may advise high-dose chemo followed by a stem cell transplant. This may be a better option for some men with recurrent disease, rather than standard chemo.
Clinical trials of newer treatments may also be good options. Typically, radical inguinal orchiectomy is the treatment for Sertoli cell and Leydig cell tumors. Radiation therapy and chemo generally don't work for these rare types of testicular tumors.
If the doctor suspects the tumor has spread beyond the testicle, the retroperitoneal lymph nodes may be surgically removed. Carcinoma in situ stage 0 testicular tumors In this stage, the cancer has not spread outside the testicle, and tumor marker levels like HCG and AFP are not elevated. Seminomas Stage I seminomas These cancers can be cured in nearly all patients.
After surgery, there are often several treatment choices: Careful observation surveillance : If the cancer has not spread beyond the testicle, the plan most experts prefer is close monitoring for up to 10 years. Stage IS seminomas In this stage, one or more tumor marker levels is still high after the testicle containing the seminoma has been removed. Stage IIA seminomas Radiation: After surgery to remove the testicle radical inguinal orchiectomy , one treatment option is radiation to the retroperitoneal lymph nodes.
Stage IIB seminomas These seminomas have spread to cause larger lymph nodes or have spread to many different lymph nodes. Non-seminomas Stage I non-seminomas Nearly all of these cancers can be cured, but the treatment is different from that of seminomas.
Choices for stage IA T1 Careful observation surveillance : Surveillance is preferred by most experts, but it requires a lot of doctor visits and tests. A typical schedule might include visits every 2 months for the first year, with CT scans every 4 to 6 months; then every 3 months for the second year, with scans every 6 to 12 months. As time goes on and you have no problems, the time between visits and tests gets longer.
If the cancer does come back relapse , it's usually within the first year or two. Relapses are generally treated with chemo. Even though more patients will have a relapse with surveillance than with lymph node dissection, the cure rates are much the same because the relapses are usually found early.
Retroperitoneal lymph node dissection RPLND : Having the lymph nodes at the back of the abdomen belly removed has the advantage of a high initial cure rate, but the disadvantages of major surgery with its possible complications, including losing the ability to ejaculate normally. Chemotherapy: Instead of surgery, the doctor may suggest 1 cycle of the BEP regimen bleomycin, etoposide, and cisplatin. This helps reduce the risk of relapse. If cancer is found in the lymph nodes, chemo is often recommended depending on the number of nodes with cancer in them.
Chemotherapy: Instead of surgery, the doctor may recommend 1 cycle of the BEP regimen bleomycin, etoposide, and cisplatin. This can help reduce the risk that the cancer will come back. If cancer was found in the lymph nodes after surgery, 2 to 4 cycles of BEP or EP etoposide and cisplatin may be given, depending on how many nodes had cancer in them.
This has a high cure rate, but it can have side effects which are mostly short-term. Careful observation surveillance : This requires frequent doctor visits and tests for several years. This may be an option for some T2 tumors that haven't reached blood vessels. Stage II non-seminomas Surgery is done first to remove the testicle and spermatic cord called a radical inguinal orchiectomy.
Stage IIA non-seminomas Treatment depends on tumor marker levels after surgery and the extent of spread to the retroperitoneal lymph nodes. If tumor marker levels are normal, there are 2 main options: Retroperitoneal lymph node dissection RPLND : This is surgery to remove the lymph nodes at the back of the abdomen.
This means there's less chance of nerve damage occurring. Nerve-sparing RPLND is currently only available at specialist centres that employ surgeons with the required training.
Laparoscopic retroperitoneal lymph node dissection LRPLND is a type of keyhole surgery that can be used to remove the lymph nodes. An instrument called an endoscope is inserted into 1 of the cuts. An endoscope is a thin, long, flexible tube with a light and a camera at 1 end, enabling images of the inside of your body to be relayed to an external television monitor. Small surgical instruments are passed down the endoscope and can be used to remove the affected lymph nodes. But as LRPLND is a new technique, there's little available evidence regarding the procedure's long-term safety and effectiveness.
If you're considering LRPLND, you should understand there are still uncertainties about the safety and effectiveness of the procedure. Radiotherapy uses high-energy beams of radiation to help destroy cancer cells. It may also be needed in advanced cases where someone is unable to tolerate the complex chemotherapies usually used to treat stage 2 and 3 testicular cancer. If testicular cancer has spread to your lymph nodes, you may require radiotherapy after a course of chemotherapy.
These side effects are usually only temporary and should improve when your treatment is completed. Chemotherapy uses powerful medicines to kill the malignant cancerous cells in your body or stop them multiplying. You may require chemotherapy if you have advanced testicular cancer or it's spread within your body. It's also used to help prevent the cancer returning. In some cases, a special tube called a central line is used, which stays in a vein throughout your treatment so you do not have to keep having blood tests or needles placed in a new vein.
Sometimes chemotherapy medicines can attack your body's normal, healthy cells. This is why it can have many different side effects. These side effects are usually only temporary and should improve after you have completed your treatment.
Side effects, such as infections that occur when you have a low blood count, can be life threatening, and it's essential that you always call your cancer care team if you're worried between chemotherapy treatments. You should discuss this with your doctors if damage to your lungs would have specific issues for your career or lifestyle. You should not father children while having chemotherapy and for a year after your treatment has finished. This is because chemotherapy medications can temporarily damage your sperm, increasing your risk of fathering a baby with serious birth defects.
You'll need to use a reliable method of contraception , such as a condom , during this time. This is to protect your partner from any potentially harmful effects of the chemotherapy medication in your sperm. Find out more about the side effects of chemotherapy.
The risk of your cancer returning will depend on what stage it was at when you were diagnosed and what treatment you have had since. Most recurrences of non-seminoma testicular cancer occur within 2 years of surgery or completion of chemotherapy. In seminomas, recurrences still occur until 3 years.
Because of the risk of recurrence, you'll need regular tests to check if the cancer has returned. Follow-up and testing is usually recommended depending on the extent of the cancer and the treatment offered. This is usually more frequent in the first year or 2, but follow-up appointments may last for up to 5 years.
If the cancer returns following treatment for stage 1 testicular cancer and it's diagnosed at an early stage, it's usually possible to cure it using chemotherapy and possibly also radiotherapy. Recurrences that happen after previous combination chemotherapy can also be cured, but the chances of this will vary between individuals and you'll need to ask your doctors to discuss this with you. Cancer Research UK has more information about follow-up for testicular cancer.
Page last reviewed: 14 June Next review due: 14 June Your recommended treatment plan will depend on: the type of testicular cancer you have — whether it's a seminoma or a non-seminoma the stage of your testicular cancer The first treatment option for all cases of testicular cancer, whatever the stage, is to surgically remove the affected testicle an orchidectomy. Further treatment is usually only needed for the small number of people who have a recurrence. For example, you may want to find out the advantages and disadvantages of particular treatments.
Orchidectomy An orchidectomy is a surgical procedure to remove a testicle. About 1 in 50 people will get a second new testicular cancer in their remaining testicle.
If both testicles are removed a bi-lateral orchidectomy , you'll be infertile. Serum marker levels are normal or only mildly increased. At least 1 serum marker is substantially elevated. At least 1 serum marker is extremely high, and the cancer has spread to at least 1 lymph node or organ. Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence.
These tests and scans are often similar to those done at the time of the original diagnosis. If the disease has spread to lymph nodes or other organs, the following system is used to classify a germ cell tumor into a good, intermediate, or poor risk group. This helps to determine the treatment plan and the likelihood of cure. Patients with a tumor in the intermediate and poor risk groups usually receive more chemotherapy than patients with a tumor in the good risk group. The cancer has not spread to an organ other than the lungs and serum tumor marker levels are normal or slightly elevated, which means:.
The cancer has not spread to an organ other than the lungs and the serum tumor marker levels are intermediate, which means:. The cancer has spread to an organ other than the lungs or the serum tumor marker levels are poor, which means:.
The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide. Testicular Cancer: Stages Approved by the Cancer.
Doctors use the results from diagnostic tests and scans to answer these questions: Tumor T : How large is the primary tumor? Where is it located?
Staging for testicular cancer can also be clinical or pathological: Clinical staging is based on the results of tests other than surgery or biopsy, which may include physical examinations and imaging tests see Diagnosis. Here are more details on each part of the TNM system for testicular cancer: Tumor T Using the TNM system, the "T" plus a letter or number 0 to 4 is used to describe the size and location of the tumor. For a pure seminoma, this stage is further divided based on the side of the tumor: pT1a.
The tumor is smaller than 3 centimeters cm in size. The tumor is 3 cm or larger in size. NX: The regional lymph nodes cannot be evaluated. Metastasis M The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis. MX: Distant metastasis cannot be evaluated. M0: The disease has not metastasized to distant lymph nodes or other organs.
M1: There is at least 1 distant metastasis. Serum tumor markers S Serum tumor markers also help to stage testicular cancer. SX: Tumor marker levels are not available, or the tests have not been done. S0: Tumor marker levels are normal. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications and the S level information.
Later-stage testicular cancer: risk group classification If the disease has spread to lymph nodes or other organs, the following system is used to classify a germ cell tumor into a good, intermediate, or poor risk group. Good risk Non-seminoma. Intermediate risk Non-seminoma. Poor risk Non-seminoma. There is no poor-risk category for seminoma. Source: Journal of Clinical Oncology.
Types of Cancer. Testicular Cancer Guide. Net Guide Testicular Cancer. Medical Illustrations. Risk Factors. Symptoms and Signs. Types of Treatment. About Clinical Trials.
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