What is the treatment for testicle cancer?

Treatment of Testicular Cancer

The primary treatment for testicular cancer involves radical inguinal orchiectomy followed by stage-specific therapy including surveillance, retroperitoneal lymph node dissection (RPLND), chemotherapy, or radiation therapy, with treatment decisions based on tumor histology, stage, and risk classification. 1

Initial Diagnosis and Management

• Diagnostic approach:

  • Scrotal ultrasound to confirm testicular mass
  • Serum tumor markers (AFP, β-hCG, LDH) before orchiectomy
  • Radical inguinal orchiectomy for both diagnosis and initial treatment 2, 1
  • Post-orchiectomy staging with CT abdomen/pelvis and chest imaging

• Fertility preservation:

  • Sperm banking should be discussed before any therapeutic intervention 1

Stage-Specific Treatment

Stage I Disease

• Seminoma (Stage IA and IB):

  • Preferred: Surveillance (category 1) 2
  • Alternatives:
    • Single-dose carboplatin (AUC 7) (category 1) 2
    • Radiation therapy (20-30 Gy) to infradiaphragmatic area 2

• Non-seminoma (Stage I):

  • Low risk (no vascular invasion): Surveillance protocol 2
  • High risk (with vascular invasion): Adjuvant chemotherapy with BEP × 2 cycles 2
  • Alternative (if chemotherapy not possible): Nerve-sparing RPLND 2

Advanced Disease (Stages II-IV)

• Treatment based on IGCCCG risk classification:

  • Good prognosis: BEP × 3 cycles or EP × 4 cycles 2, 1
  • Intermediate/poor prognosis: BEP × 4 cycles 2, 1

• Post-chemotherapy management:

  • Residual masses should be surgically resected when possible 2
  • Surgery performed by experienced surgeons at high-volume centers 2

Chemotherapy Regimens

• BEP regimen:
  • Bleomycin 30,000 IU on days 1,8, and 15
  • Etoposide 100 mg/m² on days 1-5 (or 165 mg/m² on days 1-3)
  • Cisplatin 20 mg/m² on days 1-5 2, 3, 4

Follow-up and Surveillance

Stage I on Surveillance

• Physical exam, tumor markers, chest X-ray: monthly for 1st year, every 2 months in 2nd year, every 4 months in 3rd year, then every 6 months to 5 years
• CT abdomen/pelvis: at 3,6,9,12, and 24 months 2

Post-chemotherapy

• Physical exam, tumor markers, chest X-ray: every 2 months for 1st year, every 3 months for 2nd year, then every 6 months to 5 years
• CT scans only as clinically indicated 2

Important Considerations and Pitfalls

• Referral considerations:

  • Patients should be treated by oncologists with experience in testicular cancer 2
  • RPLND should be performed by experienced surgeons at high-volume centers 2

• Common pitfalls to avoid:

  • Delaying orchiectomy in suspicious cases
  • Failing to obtain tumor markers before orchiectomy
  • Not discussing fertility preservation before treatment
  • Overtreatment of stage I disease 1
  • Inadequate follow-up (testicular cancer can recur even after 5 years) 2

• Long-term survivorship concerns:

  • Monitor for cardiovascular disease, secondary malignancies, and infertility 5, 6
  • With appropriate treatment, 5-year survival rates are 99%, 92%, and 85% for stages I, II, and III respectively 5

The management of testicular cancer requires a coordinated approach with urologists, medical oncologists, and radiation oncologists to ensure optimal outcomes while minimizing treatment-related morbidity.