Cancer treatment, testicular cancer: surgery as the number 1 choice

Once a testicular tumour is diagnosed, the patient faces immediate surgery. A surgical approach through the groin is used.

If a malignant tumour is histologically confirmed, the man's entire testicle is removed. This procedure is called a radical orchiectomy.

If the tumour is bilateral, a so-called testicle-preserving operation is performed. Only the tumour is removed and the patient's testicles are then irradiated. Sperm production is irreversibly damaged, but the function of hormone production and libido is preserved.

If a man actually has both testicles removed, such patients must be treated with hormone replacement therapy.

Life without testicles requires the administration of hormone replacement therapy.

Prevention of severe osteoporosis is also important. Long-term androgen deficiency (male sex hormones) adversely affects bone metabolism and osteopenia to osteoporosis develops.

Seminomas in the first clinical stage are indicated for collateral radiotherapy after surgery. This means that the testicle and all adjacent lymph nodes are irradiated.

The entire field of irradiated tissue extends from the last rib to the groin and is approximately 10 cm wide.

Most seminomas go into remission after radiation. Only 4% recur, i.e. return as an active tumour. After relapse, the next treatment is chemotherapy.

Chemotherapy is also given if the diagnosis of a seminoma is advanced. This is stage III, when the lymph nodes are affected by metastases but the metastases have not yet spread to distant organs.

The most commonly used chemotherapy combinations include:

• bleomycin, etoposide and cysplatin in three cycles (BEP)
• etoposide and cisplatin in four cycles (EP)

Other chemotherapy drugs used:

• etoposide, ifosfamide and cisplatin (VIP)
• paclitaxel, ifosfamide and cisplatin (TIP)
• vinblastine, ifosfamide and cisplatin (VeIP) and others

Nonsymptomatic tumors are monitored after orchiectomy. If this method of monitoring is not safe, administration of one cycle of the BEP combination or irradiation of the tumor bed with surrounding lymph nodes may be considered.

Patients with persistently high oncomarker levels have a high risk of tumour recurrence. In this case, full chemotherapy consisting of 3 cycles of BEP or 4 cycles of EP or 4 cycles of VIP combination is administered.

If distant metastases are present, immediate chemotherapy is the first choice. The above combinations and number of cycles are used.