Treating the Disease


Testicular cancer is almost always curable if it is found early. This disease responds well to treatment, even if it has spread to other parts of the body.

Staging

If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, x-rays and scans, and, in some cases, additional surgery.

• Most patients have computed tomography, also call CT or CAT scan, which is a series of x-rays of various sections of the body. Some have intravenous pyelography (IVP), x-rays used with a special dye to outline the urinary system. Some doctors recommend lymphangiography, x-rays taken with a special dye that outlines the lymph system in the abdomen. Ultrasonography, which creates a picture from the echoes of high-frequency sound waves bounced off internal organs, also may be useful.
• Special lab tests can reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in patients with some types of cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has.
• Surgery may be recommended to remove the lymph nodes deep in the abdomen. A pathologist then examines the nodes to see whether they contain cancer cells. For patients with nonseminoma, removing the nodes helps stop the spread of their disease. Seminoma patients do not need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.

Planning Treatment

Decisions about treatment for testicular cancer are complex. Sometimes it is helpful to have more than one doctor's advice. Before starting treatment, the patient might want a second opinion about the diagnosis and treatment plan. It may take a week or two to arrange to see another doctor. This short delay will not make treatment less effective. There are a number of ways to find a doctor for a second opinion:

• The patient's doctor may be able to suggest a doctor who has a special interest in testicular cancer.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer centers and other NCI-supported programs in their area.
• Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.

Methods of Treating Testicular Cancer

Testicular cancer can be treated with surgery, radiation therapy, and chemotherapy. The doctor may use just one method or a combination. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.

Surgery. In most cases, surgery is done to remove the testicle. Sometimes it also is necessary to remove lymph nodes in the abdomen. In addition, tumors that have spread to other parts of the body may be partly or entirely removed by surgery.

Radiation therapy. In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local therapy; it affects only the cells in the treated area. The patient usually receives radiation therapy as an outpatient.

Seminomas are highly sensitive to radiation. Following surgery, men with seminomas generally have radiation therapy to their abdominal lymph nodes.

Nonseminomas are somewhat less sensitive to radiation. Patients with this type of cancer usually have other types of treatment.

Chemotherapy. The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread.

Also, chemotherapy is sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation. The use of anticancer drugs following surgery for early stage cancer is known as adjuvant therapy.

Chemotherapy may be given by mouth or by injection into a muscle or a blood vessel. Chemotherapy is a systemic treatment--the drugs enter the bloodstream and reach cells all over the body. Depending on the specific drugs and the patient's general condition, chemotherapy may be taken as an outpatient--at the hospital, at the doctor's office, or at home. Sometimes, however, the person must be hospitalized for a time, so the effects of the treatment can be watched.

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