Treating Localised and Metastatic Testicular Cancer

Testicular cancer is among the most curable cancers, and treatment is highly effective even when the cancer has spread. The plan depends on the type (seminoma or non-seminoma), the stage, and the tumour markers. Treatment usually begins with an operation to remove the affected testicle, followed — depending on the findings — by monitoring, a course of chemotherapy, or, in selected cases, further surgery.

The first step is almost always to remove the affected testicle, through a small cut in the groin — an operation called a radical orchidectomy. This both treats the cancer and, by examining the removed tissue, confirms the exact type. It is a short operation, usually as a day case or one overnight stay.

Two things are worth discussing beforehand. Sperm banking — storing a sperm sample before treatment — is offered to men who may wish to have children in the future, because both the cancer and its treatment may affect fertility. And a testicular prosthesis — a natural-feeling implant placed in the scrotum — can be fitted at the time of the operation or later. Most men retain normal fertility and hormone levels with one remaining testicle.

After the testicle is removed, the type, the stage, and the tumour markers are reviewed together to decide what — if anything — is needed next.

Surveillance (active monitoring). For many men with stage 1 disease, no further treatment is needed after the operation, and the safest course is close monitoring — regular check-ups, tumour-marker blood tests, and scans. Most men are cured by the operation alone, and surveillance avoids unnecessary treatment while catching the small number of recurrences early, when they remain very treatable.

Adjuvant chemotherapy (a single dose). For some stage 1 seminomas, a single dose of chemotherapy (carboplatin) may be given after the operation to lower the chance of the cancer returning. A large randomised trial (the MRC TE19 / EORTC 30982 study) showed that one dose of carboplatin is as effective as the radiotherapy previously used, with fewer long-term effects. The alternative to this is close surveillance.

Chemotherapy for spread or raised markers. If the cancer has spread (stage 2 or 3), or if tumour markers remain raised after the testicle is removed — a sign that cancer remains — a course of combination chemotherapy is given. The standard combination is known as BEP (bleomycin, etoposide and cisplatin) and is highly effective. The number of cycles depends on the stage and outlook.

Surgery for lymph nodes (RPLND). In selected cases — for example some non-seminomas, or when a mass remains in the abdomen after chemotherapy — an operation to remove the lymph nodes at the back of the abdomen may be advised. This is called retroperitoneal lymph node dissection (RPLND). It is a specialised procedure used in specific situations rather than routinely: for some men it removes any remaining active cancer, while for others it removes tissue left behind after chemotherapy to confirm that no active cancer remains. Your team will explain if it applies to you.