Testicular Cancer Treatment

Testicular cancer begins in the testes, two male reproductive glands that produce sperm and testosterone. Most testicular tumors originate from germ cells, which are responsible for sperm production. Scientists believe these tumors develop when healthy germ cells undergo genetic changes that cause them to grow uncontrollably. As the abnormal cells multiply, they can accumulate and form a tumor.

Although testicular cancer is relatively uncommon, it is the most frequently diagnosed cancer in men between the ages of 15 and 35. The exact cause is not fully understood, but certain factors may increase the risk. These include an undescended testicle, a genetic condition, such as Klinefelter’s syndrome, and a family history of testicular cancer.

Common symptoms of testicular cancer include a painless lump or swelling in one testicle, a feeling of heaviness in the scrotum and a dull ache in the lower abdomen or groin. The diagnostic process usually involves a physical examination, scrotal ultrasound and blood work to check for tumor markers. Additional imaging or surgery may be performed to confirm the diagnosis and determine the stage.

Testicular cancer is highly treatable, especially when it is diagnosed early. Even in cases where the cancer has spread beyond the testicles, the likelihood of successful treatment remains high. With modern medical advances, most patients respond well to therapy and can maintain an active, healthy lifestyle.

Typically, treatment for testicular cancer involves surgical removal of the affected testicle. Surgery is sometimes combined with chemotherapy, radiation therapy or additional surgery to remove nearby lymph nodes. The specific treatment approach can vary depending on the type and stage of the cancer. Regular follow-up care is also important to monitor for recurrence and support long-term health.

Surgery for testicular cancer

Surgery is often the first and most important step in testicular cancer treatment. In many cases, removal of the cancerous testicle is both diagnostic and therapeutic, helping to confirm the type and stage of cancer while also eliminating the primary tumor.

What does surgery for testicular cancer involve?

The standard surgical treatment for testicular cancer is a radical inguinal orchiectomy. During this procedure, the surgeon will remove the affected testicle through a small incision in the groin, rather than the scrotum, to minimize the risk of spreading cancer cells. The procedure also involves removing the spermatic cord—which contains blood vessels, nerves and lymphatic vessels connected to the testicle—typically up to the point where it enters the abdominal cavity.

In some cases, particularly when testicular cancer has spread to nearby lymph nodes, a retroperitoneal lymph node dissection (RPLND) may be considered. Usually performed by a specialized urologic surgeon, this additional procedure involves removing lymph nodes located deep within the abdomen.

What are the potential benefits of surgery for testicular cancer?

Surgical treatment for testicular cancer offers several key benefits, including:

• Definitive diagnosis – Tissue removed during the procedure can be microscopically examined by a pathologist to confirm the type and stage of the cancer.
• Cancer control – For an early-stage testicular tumor, surgery alone may be curative.
• Treatment planning – Surgical findings can help the physician determine whether additional treatment, such as chemotherapy or surveillance, is needed.
• Low complication rate – Most men recover well from testicular cancer surgery with minimal risk of long-term complications.

In most cases, removing one testicle does not affect a man’s ability to achieve an erection or father children. However, as a precaution, sperm banking may be recommended before surgery to preserve fertility, especially if additional treatment, such as chemotherapy or radiation therapy, is anticipated.

What is the recovery process like?

Recovery from a radical inguinal orchiectomy is usually straightforward. Most patients go home the same day and return to their normal activities within one to two weeks. Common post-operative instructions include:

• Limiting strenuous activity for a short time
• Managing mild discomfort with over-the-counter pain relievers
• Wearing supportive underwear to reduce swelling

If lymph node surgery is performed, recovery may take longer and involve a brief hospital stay. Follow-up appointments will be scheduled to monitor healing, review pathology results and discuss whether further treatment is needed.

Tommy turned 18 years old and received news he was shocked to hear: testicular cancer. "Moving to Moffitt saved my life," he says.

Tommy, Testicular Cancer Survivor

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Chemotherapy for testicular cancer

Chemotherapy is often a key component of testicular cancer treatment, particularly for non-seminomatous germ cell tumors (NSGCTs) and cancer that has spread beyond the testicle. It may also be used to reduce the risk of seminoma recurrence by targeting microscopic cancer cells that remain after surgery.

What does chemotherapy for testicular cancer involve?

Chemotherapy uses a combination of potent medications to destroy rapidly dividing cancer cells throughout the body. In the treatment of testicular cancer, chemo drugs are usually administered intravenously in cycles. Each cycle is followed by a rest period, allowing the patient’s body time to recover from any side effects before the next round begins.

The most common chemotherapy regimen for testicular cancer is known as BEP, which includes:

• Bleomycin
• Etoposide
• Cisplatin

Treatment is typically given over several weeks during outpatient visits to an infusion center. The specific number of cycles can vary depending on the stage of the tumor and the patient’s overall health.

What are the potential benefits of chemotherapy for testicular cancer?

Chemotherapy can be highly effective in treating testicular cancer, even when the tumor has spread to other parts of the body, such as the lymph nodes or lungs. This systemic treatment can:

• Shrink a tumor before or after surgery
• Eliminate microscopic cancer cells that remain after surgery
• Significantly reduce the risk of cancer recurrence
• Cure certain cases of advanced-stage testicular cancer

Modern, highly targeted drug regimens combined with personalized supportive care contribute to an excellent long-term outcome and quality of life for most patients with testicular cancer.

What are the possible side effects of chemotherapy for testicular cancer?

Chemotherapy targets rapidly dividing cells throughout the body, which means it can also affect certain healthy cells. The side effects can vary based on the specific drugs used and the patient’s tolerance, but may include:

• Fatigue
• Nausea and vomiting
• Hair loss
• Reduced appetite
• Mouth sores
• Increased risk of infection (due to low white blood cell counts)
• Numbness or tingling in the hands and feet (neuropathy)
• Fertility changes

Some side effects are temporary and manageable, while others—such as changes in fertility—may be long-lasting. The patient will be closely monitored during treatment to manage any side effects and adjust the care plan as needed.

What is the recovery process like?

Recovery from chemotherapy can vary depending on the intensity and duration of the treatment and the patient’s overall health. Most patients begin to regain their energy within a few weeks, although certain side effects, such as nerve damage and fertility issues, may take longer to improve or stabilize.

Follow-up care typically involves periodic medical evaluations, including:

• Blood work, such as tumor marker tests
• Imaging scans
• Physical exams

During follow-up visits, the physician will monitor the treatment’s effectiveness and check for any early signs of recurrence. With appropriate medical guidance, many patients gradually resume their regular activities.

Radiation therapy for testicular cancer

Radiation therapy is occasionally included as part of a treatment plan for testicular seminoma, a type of germ cell tumor known for its sensitivity to radiation. In contrast, it is generally not used for non-seminomatous germ cell tumors, which are less responsive to this treatment approach. When appropriate, radiation therapy may be administered to help prevent recurrence or target cancer that has spread to nearby lymph nodes.

External beam radiation therapy (EBRT) for testicular cancer

EBRT is the most frequently used form of radiation treatment for testicular seminoma. This technique delivers high-energy X-rays from an external linear accelerator, which precisely targets the cancer-affected areas of the body. Often, the beams are directed at the para-aortic lymph nodes in the abdomen, a common site of testicular cancer metastasis.

What are the potential benefits of external beam radiation therapy for testicular cancer?

EBRT can help eliminate microscopic cancer cells that remain after surgery, helping to lower the risk of recurrence. For a patient with stage 1 or stage 2 testicular seminoma, it may be administered after a radical inguinal orchiectomy or as a primary treatment for limited lymph node involvement.

What are the possible side effects of external beam radiation therapy for testicular cancer?

Common side effects of EBRT include:

• Fatigue
• Nausea
• Diarrhea
• Skin irritation
• Gastrointestinal discomfort
• Mild urinary symptoms
• Temporary or long-term fertility changes

What is the recovery process like?

Recovery from EBRT is generally straightforward, with most patients returning to their normal activities within a few weeks after completing treatment. The side effects often resolve gradually over time, and follow-up appointments will be scheduled to monitor the patient’s progress and address any concerns.

Intensity-modulated radiation therapy (IMRT) for testicular cancer

IMRT is an advanced form of external beam radiation that enables highly precise treatment. Through computer-guided planning, the physician can fine-tune the intensity of the treatment and shape the radiation beams to match the exact contours of the tumor. As a result, an effective dose of radiation can be delivered to the cancerous tissue while sparing the surrounding healthy structures.

What are the potential benefits of intensity-modulated radiation therapy for testicular cancer?

IMRT can be particularly beneficial when the tumor is located near vital or sensitive organs, such as the kidneys or intestines. By adjusting the intensity of the radiation beams, the physician can reduce the risk of damage to healthy tissues and lower the likelihood of treatment-related complications.

What are the possible side effects of intensity-modulated radiation therapy for testicular cancer?

The side effects of IMRT are generally similar to those associated with standard EBRT, although they may be less pronounced due to the increased precision of treatment. Some individuals may experience fatigue, mild gastrointestinal discomfort or skin irritation in the treated area. However, with meticulous planning and modern treatment techniques, the risk of serious side complications is significantly reduced.

What is the recovery process like?

Most patients tolerate IMRT well, recover quickly and resume their normal routine shortly afterward. Follow-up care will include periodic imaging and lab work to assess the treatment response and monitor for recurrence.

Stereotactic body radiation therapy (SBRT) for testicular cancer

SBRT is an advanced technique that delivers a concentrated dose of radiation to a small, precisely targeted area over a limited number of sessions. While this treatment approach is not commonly used for testicular cancer, it may be considered in select cases involving isolated metastasis or recurrence, particularly when surgery or chemotherapy is not an option. Its high degree of accuracy helps limit radiation exposure to the surrounding healthy tissues.

What are the potential benefits of stereotactic body radiation therapy for testicular cancer?

In select cases, SBRT may offer a noninvasive alternative for managing an isolated tumor with high precision and minimal disruption to the surrounding tissues. The relatively short treatment schedule can be convenient for the patient and may lead to faster symptom relief.

What are the possible side effects of stereotactic body radiation therapy for testicular cancer?

Because SBRT targets a small area of the body, its side effects tend to be limited. Some patients may experience temporary fatigue or localized discomfort, depending on the treatment site. Serious side effects are rare but can occur if nearby organs are affected.

What is the recovery process like?

Recovery after SBRT is usually rapid, with most patients resuming their normal activities almost immediately afterward. Continued follow-up will be important to evaluate the effectiveness of treatment and manage any late-onset side effects.

Benefit from world-class care at Moffitt Cancer Center

Moffitt’s renowned Urologic Oncology Program is firmly positioned on the leading edge of testicular cancer research and treatment. Through our robust portfolio of clinical trials, our patients have unique opportunities to benefit from promising new therapies that are not yet available in other settings. For these reasons and many others, the National Cancer Institute (NCI) has designated Moffitt a Comprehensive Cancer Center.

If you would like to learn more about testicular cancer treatment, you can request an appointment with a specialist in the Urologic Oncology Program at Moffitt by calling 1-888-663-3488  or submitting a new patient registration form online. We do not require referrals.