Treatment & Management

of Testicular Cancer

Testicular cancer is broadly divided into two different types, seminoma and non-seminoma.  This classification is based on the appearance of cells under the microscope.  Treatment planning depends upon the stage of the cancer and whether the testicular cancer is classified as seminoma or non-seminoma. Seminomas are more sensitive to radiation therapy and are easier to cure than non-seminomas. Patients with all stages of seminoma have a cure rate that exceeds 90%, and patients with seminoma confined to the testicle have a cure rate approaching 100%. If there is a mixture of seminoma and non-seminoma components upon examination under the microscope, the cancer is diagnosed as non-seminoma because the cancer will be more aggressive due to the non-seminoma part of the cancer.1,2

Nonseminoma cell types include:

  • Embryonal carcinoma
  • Teratoma,
  • Yolk sac carcinoma
  • Choriocarcinoma
  • Mixed cell type

Treatment for testicular cancer is tailored to each individual and may include surgery, radiation therapy, and systemic treatment with chemotherapy or precision cancer medicines.

Surgery. Surgery is a common treatment for testicular cancer. The type of surgery depends largely on the stage and the grade of the cancer.

Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink the cancer or after surgery to kill any remaining cancer cells.

  • External radiation. This is usually done at least several days per week on an outpatient basis for several weeks. The high-energy rays are concentrated on the cancerous area from outside the body.

Learn more about radiation here.

Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Some patients with early stage cancers already have small amounts of cancer that have spread away from the pancreas that cannot be treated with surgery or radiation. These patients require systemic treatment to decrease the chance of cancer recurrence.  More advanced cancers that cannot be treated with surgery and radiation can only be treated with systemic therapy.   Systemic therapies commonly used in the treatment of cancer include:

Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period.

Precision Cancer Medicines

The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are just beginning to undergo evaluation in testicular cancer and patients should ask their doctor about whether testing is appropriate. Learn more about precision cancer medicines.

Learn about treatment of testicular cancer by type and stage:

Seminoma Testicular Cancer

Stage I Seminoma: Stage I testicular cancer is limited to the testes. Pathologic Stage I cancer refers to patients who have a lymph node dissection that is free of cancer. Clinical Stage I cancer is used to classify patients who do not undergo a lymph node dissection.

Stage II Seminoma: Stage II testicular cancer involves the testes and the retroperitoneal lymph nodes. Retroperitoneal lymph node involvement is further characterized by the number and size of involved lymph nodes.

Stage III Seminoma: Stage III testicular cancer has spread beyond the retroperitoneal lymph nodes. Stage III seminoma is subdivided into “non-bulky” Stage III and “bulky” Stage III based on the amount of cancer present at diagnosis.

Recurrent and/or Refractory Seminoma: Cancer has returned or progressed after primary treatment and may be resistant to chemotherapy.

Non-Seminoma Testicular Cancer

Stage I Nonseminoma: Stage I testicular cancer is limited to the testes. Pathologic Stage I cancer refers to patients who have a lymph node dissection that is free of cancer. Clinical Stage I cancer is used to classify patients who do not undergo a lymph node dissection. A retroperitoneal lymph node dissection detects cancer spread in 15–30% of patients whose diagnostic tests indicated no spread prior to surgery.

Stage II Nonseminoma: Stage II testicular cancer involves the testes and the retroperitoneal lymph nodes. Retroperitoneal lymph node involvement is further characterized by the number and size of involved lymph nodes.

Stage III Nonseminoma: Stage III testicular cancer has spread beyond the retroperitoneal lymph nodes. Stage III testicular cancer is subdivided into “non-bulky” Stage III and “bulky” Stage III based on the amount of tumor present at diagnosis.

Recurrent and/or Refractory Nonseminoma: Cancer has returned after primary treatment and may be resistant to chemotherapy.

References


1 American Cancer Society: Cancer Facts and Figures 2017. Atlanta, Ga: American Cancer Society, 2017.

2 Ries LAG, Melbert D, Krapcho M, et al.: SEER Cancer Statistics Review, 1975-2005. Bethesda, Md: National Cancer Institute, 2007.