Testicular Cancer Treatment Options By Type and Stage

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The testicular cancer treatment depends on the type of testicular cancer (seminoma versus non-seminoma), stage of the disease, performance status of the patient, along with other factors.

Following are the preferred treatment approaches for different stages of testicular germ cell tumor, but the final decision is taken after clinical assessment of the patient by an oncologist.

non seminoma testicular cancer treatment
Non Seminoma Testicular Cancer Treatment
Seminoma Testicular Cancer Treatment
STAGE TNM TYPE TREATMENT
0 Tis N0 M0 S0 Seminoma Surveillance is generally preferred approach for patients with Stage 0 seminomas. The patient should be screened frequently for any sign of disease progression. No other treatment is generally recommended.
I T1-4 N0 M0 Sx Seminoma In case of Stage I seminomas, high inguinal orchiectomy (complete removal of the affected testicle) followed by surveillance is the preferred option, mainly for T1-T3 disease. However, chemotherapy or radiation therapy is also an option after high inguinal orchiectomy.
    Non-seminoma In case of Stage I non-seminomas, high inguinal orchiectomy followed by surveillance is preferred for T1 disease. However, for T2-T4 tumors, chemotherapy or nerve-sparing retroperitoneal lymph node dissection (RPLND) are preferred after high inguinal orchiectomy.
II Any T N1-3 M0 Sx Seminoma In case of Stage II seminomas, high inguinal orchiectomy followed by radiotherapy (for non-bulky disease or stage IIA) or chemotherapy (for bulky disease or stage IIB/IIC) is considered as the standard treatment.
    Non-seminoma In case of Stage II non-seminomas, high inguinal orchiectomy followed by RPLND (for non-bulky disease or stage IIA; with tumor marker(s) normal) or chemotherapy (for bulky disease or stage IIB/IIC, or tumor marker(s) elevated) is considered as the standard treatment.
III Any T Any N M1 Sx Seminoma and
Non-seminoma
In case of Stage III seminomas and non-seminomas, radical inguinal orchiectomy followed by chemotherapy is the standard treatment. Radiation therapy and/or other palliative treatment may be given for relief of symptoms.

Following is the brief description of various testicular cancer treatment:

  1. Surgery: Mainly 2 types of surgeries are performed for testicular cancer treatment: High inguinal orchiectomy and retroperitoneal lymph node dissection (RPLND). In high inguinal orchiectomy, the affected testicle, spermatic cord, and associated blood and lymph vessels (that can provide passage for cancer spread) are removed.

    In RPLND, the cancer-containing lymph nodes in the abdomen (known as retroperitoneal lymph nodes surrounding the aorta and inferior vena cava) are removed. RPLND can be performed as an open surgery or as a laparoscopic procedure. Also, some patients may opt for sperm banking for fertility preservation before the surgery.

  2. Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy).

    Radiotherapy is generally recommended for seminoma it responds well to radiation. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.

  3. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for testicular germ cell tumor as it is a highly chemosensitive tumor.

    Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.

It is very important to assess the benefits of each testicular cancer treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals for testicular cancer treatment:

  • Prolongation of life.
  • Reduction of symptoms.
  • Improvement in quality of life.

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Treatment for Seminoma Testicular Cancer:

Video Transcript:

The seminoma testicular cancer treatment depends on whether it is seminoma or non-seminoma.

First, we will discuss the treatment for seminoma. The treatment options for stage 1 seminoma are surveillance, radiation therapy or chemotherapy.

Surveillance is usually preferred from T1 to T3 disease. The final decision is taken by the oncologist after assessing the patient’s condition and discussing all the treatment options with the patient.

For stage 2 seminoma, the treatment depends on whether it is stage 2A, 2B or 2C. For stage 2A, the treatment options are radiotherapy and chemotherapy. For stage 2B also, chemotherapy and radiotherapy are the treatment options but chemotherapy is preferred over radiotherapy in most of the cases. And for stage 2C, chemotherapy is the treatment of choice.

For stage 3 disease also, chemotherapy is the treatment of choice. So these were the treatment options for seminomatous germ cell tumor, but the final decision is taken by the oncologist after assessing the condition of the patient and discussing with the patient the toxicities with various treatments.

CancerBro, after I received the chemotherapy for seminoma, the doctor did a surgery. He told me I had some residual disease after chemotherapy. Yes, in some cases of seminoma, the residual disease may be present even after chemotherapy.

In such cases, surgery may be required depending upon the scan findings and if a viable tissue is found after surgery further chemotherapy is given.

Treatment for Non Seminoma Testicular Cancer: 

Video Transcript:

Now we come to the Non-seminoma testicular cancer treatment.

The treatment options for stage 1 non-seminoma are surveillance, surgery or chemotherapy. Surveillance is usually preferred in T1 disease.

The surgery that is done for non-seminomatous germ cell tumors is called as retroperitoneal lymph node dissection or RPLND. Treatment for stage 2 non-seminoma depends on whether the markers are S0 or S1, that is whether they are normal or elevated. If the markers are elevated, then chemotherapy is the treatment of choice. For stage 2 disease with normal markers, the treatment depends on whether it is stage 2A, 2B or 2C. For stage 2A disease, the treatment options are surgery or chemotherapy.

For stage 2B disease also, the treatment options are the same, but chemotherapy is preferred over surgery. And for stage 2C disease, chemotherapy is the treatment of choice. For stage 3 disease also, chemotherapy is the treatment of choice. So, these were the treatment options for non-seminomatous germ cell tumors.

Again, always remember that of all the treatment options the final decision is taken by the oncologist, after assessing the condition of the patient and discussing the various treatment option with the patient.

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