The testicles are a pair of egg-shaped male sex glands that produce testosterone hormone and sperm. Germs cells present within the testicles that produce immature sperm are mostly the origin of testicular cancer. Testicular cancer commonly occurs in men within the 20 to 35 years age group. Seminomas and nonseminomas are two primary types of tumors that develop in testicular germ cells. However, each of these types of tumors spread differently. The treatment plan differs depending upon the tumor type.
It has been found that the Nonseminomas type of tumor grows and spreads quicker than seminomas. However, some testicular cancer contains both seminomas and nonseminomas tumors. In such cases, testicular cancer is considered a nonseminoma.
Treatment
The testicular cancer treatment plan depends upon the stage and type of cancer, side effects of the treatment, patient preference, and general health condition. The most common treatment approach to treat testicular cancer is a surgical intervention to remove the testicles. But chemotherapy is applied first in case of cancer spreads to other body parts.
However, doctors recommend chemotherapy or radiation therapy after surgical removal.
Chemotherapy is effective to cure germ cell tumors even after it has spread. But teratoma is a germ cell tumor that insensitive to chemotherapy and does not effectively treat in the same way. Surgical removal can help to treat teratoma. Often non-seminomas are a blend of teratoma and other types of germ cell tumors. In such cases, chemotherapy followed by surgical intervention can remove any of the remaining tumors. Doctors recommend radiation therapy for early-stage seminoma or cancer that has spread to the brain.
Patients with testicular cancer can clear their doubt about their fertility, sexual health, and quality of life because of assigned treatment by discussing with the doctor.
Surgery
Orchiectomy
An incision is made in the groin to remove cancerous testicles. This surgery is termed inguinal orchiectomy or radical orchiectomy. In this surgery, the affected testicle along with most of the spermatic cord completely removed. The spermatic cord circulates the blood to the testicles and the network that involve in transferring sperm from the testicle to the penis. In some patients, both the testicles may have cancerous growth at the same time or at different times. But such incidence is rare. However, if this happens, then both the testicles need to remove and the process is termed a bilateral orchiectomy. In such cases, reconstructive surgery for implanting an artificial or prosthetic testicle is possible if patients prefer to reconstruct the testicles after orchiectomy. Orchiectomy is also used to diagnose and treat both early-stage and later-stage seminoma and non-seminoma. Doctors always suggest surveillance after orchiectomy through regular doctor appointments for physical examinations, blood tests for tumor markers, CT scans, and chest x-rays to avoid further complications.
Side effects of Orchiectomy
Usually, removal of one testicle does not cause testosterone deficiency and infertility if another testicle is intact. But if orchiectomy removes the testicles, then testosterone deficiency and infertility are common side effects. Some common consequences of these include depression or mood swings, libido, fatigue, inability to erection, and hot flashes, loss of muscle and bone mass in the long term.
Retroperitoneal lymph node dissection (RPLND)
This is another surgical intervention to remove the retroperitoneal lymph nodes that lie at the back of the abdomen. In this surgery, an incision is made at the lower part of the middle abdomen. The highly skilled and experienced surgeon requires performing RPLND. RPLND is the primary treatment approach for stage I and stage IIA non-seminoma. This surgical intervention can reduce the risk of recurrence and helps to stage cancer. RPLND is also recommended for testicular patients with stage II or stage III non-seminoma and residual tumor masses are remain even after completing chemotherapy. RPLND is also a treatment option for patients with seminoma.
The temporary side effect of RPLND is bowel obstruction or infection. But it does not cause any difficulty in erection, orgasm, or sexual intercourse. But many patients have a complaint of infertility after RPLND. Therefore, doctors need to discuss with the patient all the possible side effects and measures to overcome the problems.
Apart from these, surgical processes, depending upon the spreading of cancer may require additional surgical processes depending upon the involved organ. But usually, these types of surgeries are complicated.
Chemotherapy
The following chemotherapeutic drugs are recommended for testicular cancer. But these are not fixed regimens. Doctors can use other than the mentioned drugs to testicular cancer. Following are generic chemotherapeutic agents used for testicular cancer treatment.
- Bleomycin
- Carboplatin
- Cisplatin
- Etoposide
- Gemcitabine
- Ifosfamide
- Oxaliplatin
- Paclitaxel
- Vinblastine
The following chemotherapy regimens may be used for testicular cancer.
- BEP: bleomycin, etoposide, and cisplatin
- Carboplatin (for stage I pure seminoma only)
- EP: etoposide and cisplatin
- TIP: paclitaxel, ifosfamide, and cisplatin
- VeIP: vinblastine, ifosfamide, and cisplatin
- VIP: etoposide, ifosfamide, and cisplatin
- High-dose carboplatin and etoposide
- Gemcitabine, paclitaxel, and oxaliplatin
Chemotherapy has side effects. Doctors should discuss with the patient the possible side effects.
Radiation therapy
Radiation therapy is applied to treating stage I or stage II pure seminoma usually directed at lymph nodes in the abdomen. Sometimes, the radiation therapy is directly given at the lymph nodes on the same side of the pelvis from where testicular cancer is originated. However, currently, radiation therapy is less frequently uses for stage I seminoma. Nowadays, chemotherapy is more frequently used in such cases to avoid cardiac diseases. However, radiation therapy is a treatment option for stage I, IIA, and IIB pure seminoma. In case of involvement of the brain in testicular cancer can also need radiation therapy. However, the scope of testicular cancer in the brain is less frequent.
Some common side-effects of radiation therapy are fatigue, upset stomach upset, loose bowel movements, mild skin reactions, and peptic ulcers. Medications may help to prevent or reduce nausea and vomiting during radiation therapy. Most of these side effects are self-limited and go away after withdrawal from the treatment. Radiation therapy may cause difficulty in sperm production, but newer radiation techniques have no such side effects.
References
- https://www.cancer.net/cancer-types/testicular-cancer/types-treatment
- https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq
