Testicular Cancer

General Information | Treatment Options | Screening | Additional Resources

Treatment Options
  • Overview
  • Standard Treatment
  • Clinical Trials
  • By Stage

There are different types of treatment for patients with testicular cancer.

Different types of treatments are available for patients with testicular cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Testicular tumors are divided into 3 groups, based on how well the tumors are expected to respond to treatment. Good Prognosis

For nonseminoma, all of the following must be true:

  • The tumor is found only in the testicle or in the retroperitoneum (area outside or behind the abdominal wall); and
  • The tumor has not spread to organs other than the lungs; and
  • The levels of all the tumor markers are slightly above normal.

For seminoma, all of the following must be true:

  • The tumor has not spread to organs other than the lungs; and
  • The level of alpha-fetoprotein (AFP) is normal. Beta-human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH) may be at any level.

Intermediate Prognosis

For nonseminoma, all of the following must be true:

  • The tumor is found in one testicle only or in the retroperitoneum (area outside or behind the abdominal wall); and
  • The tumor has not spread to organs other than the lungs; and
  • The level of any one of the tumor markers is more than slightly above normal.

For seminoma, all of the following must be true:

  • The tumor has spread to organs other than the lungs; and
  • The level of AFP is normal. β-hCG and LDH may be at any level.

Poor Prognosis

For nonseminoma, at least one of the following must be true:

  • The tumor is in the center of the chest between the lungs; or
  • The tumor has spread to organs other than the lungs; or
  • The level of any one of the tumor markers is high.

There is no poor prognosis grouping for seminoma testicular tumors.

 

Three types of standard treatment are used:

Surgery

Surgery to remove the testicle (radical inguinal orchiectomy) and some of the lymph nodes may be done at diagnosis and staging. (See the General Information and Stages sections of this summary.) Tumors that have spread to other places in the body may be partly or entirely removed by surgery.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Men who have had testicular cancer have an increased risk of developing cancer in the other testicle. A patient is advised to regularly check the other testicle and report any unusual symptoms to a doctor right away.

Lifelong clinical exams are very important. The patient will probably have check-ups once per month during the first year after surgery, every other month during the next year, and less often after that.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage I Testicular Cancer

Treatment of stage I testicular cancer depends on whether the cancer is a seminoma or a nonseminoma.

Treatment of seminoma may include the following:

  • Surgery to remove the testicle, with or without radiation therapy to lymph nodes in the abdomen after the surgery, with lifelong follow-up.
  • Surgery to remove the testicle, followed by chemotherapy and lifelong follow-up.

Treatment of nonseminoma may include the following:

  • Surgery to remove the testicle and lymph nodes in the abdomen, with lifelong follow-up.
  • Surgery to remove the testicle, with lifelong follow-up.
  • Surgery followed by chemotherapy for patients at high risk of recurrence, with lifelong follow-up.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I malignant testicular germ cell tumor.

Stage II Testicular Cancer

Treatment of stage II testicular cancer depends on whether the cancer is a seminoma or a nonseminoma.

Treatment of seminoma may include the following:

  • When the tumor is 5 centimeters or smaller, treatment is usually surgery to remove the testicle followed by radiation therapy to lymph nodes in the abdomen and pelvis, with lifelong follow-up.
  • When the tumor is larger than 5 centimeters, treatment is usually surgery to remove the testicle followed by combination chemotherapy or radiation therapy to lymph nodes in the abdomen and pelvis, with lifelong follow-up.

Treatment of nonseminoma may include the following:

  • Surgery to remove the testicle and lymph nodes, with lifelong follow-up.
  • Surgery to remove the testicle and lymph nodes, followed by combination chemotherapy and lifelong follow-up.
  • Surgery to remove the testicle followed by combination chemotherapy and a second surgery if cancer remains, with lifelong follow-up.
  • Combination chemotherapy before surgery to remove the testicle, for cancer that has spread and is thought to be life-threatening.
  • A clinical trial of combination chemotherapy instead of removing the lymph nodes.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II malignant testicular germ cell tumor.

Stage III Testicular Cancer

Treatment of stage III testicular cancer depends on whether the cancer is a seminoma or a nonseminoma.

Treatment of seminoma may include the following:

  • Surgery to remove the testicle followed by combination chemotherapy. Any tumor remaining after treatment will need lifelong follow-up.
  • A clinical trial of a new therapy.
  • A clinical trial of high-dose chemotherapy with bone marrow transplant.

Treatment of nonseminoma may include the following:

  • Surgery to remove the testicle, followed by combination chemotherapy.
  • Combination chemotherapy followed by surgery to remove any remaining tumor. Additional chemotherapy may be given if the tumor tissue removed contains cancer cells that are growing.
  • Combination chemotherapy combined with radiation therapy to the brain for cancer that has spread to the brain.
  • Combination chemotherapy before surgery to remove the testicle, for cancer that has spread and is thought to be life-threatening.
  • A clinical trial of a new therapy.
  • A clinical trial of high-dose chemotherapy with bone marrow transplant.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III malignant testicular germ cell tumor.

Treatment Options for Recurrent Testicular Cancer

Treatment of recurrent testicular cancer may include the following:

  • Combination chemotherapy.
  • High-dose chemotherapy with bone marrow transplant.
  • Surgery to remove cancer that has either:
    • come back more than 2 years after complete remission; or
    • come back in only one place and does not respond to chemotherapy.
  • A clinical trial of a new therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent malignant testicular germ cell tumor.

Cancer information from the NCI PDQ service