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Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?
Get the facts
For most men faced with testicular cancer, surgery to remove the testicle is the first treatment. After that surgery, you and your doctor must decide what to do next. For stage 1 seminoma testicular cancer, these are your choices:
- Try surveillance. This means following a schedule of frequent checkups and tests.
- Have radiation treatment to kill any stray cancer cells.
- Have chemotherapy to kill any stray cancer cells.
This decision aid is about stage I seminoma testicular cancer. The treatment decision for stage I nonseminoma testicular cancer is different.
Key points to remember
- Testicular cancer is highly curable, especially when it is found early.
- Radiation or chemotherapy are the surest ways to keep cancer from coming back. But radiation and chemotherapy have risks and side effects. Surveillance lets you avoid these risks and side effects, or at least lets you put them off for a while.
- About 80 to 85 out of 100 men who choose surveillance are cured. They don't have to worry about future treatment. This means that about 15 to 20 of those 100 men do need treatment later.1
- For surveillance, you must be willing to have frequent checkups and tests. Without this close follow-up, if the cancer comes back, it might not be found until it has spread and is harder to treat.
- If your cancer comes back and is found early, you will have the same chances for survival as men who had treatment right after their surgery.
- If you don't want to do surveillance but are worried that other treatment might harm your fertility, ask your doctor about banking your sperm before treatment.
There are two main types of testicular cancer: seminoma and nonseminoma. Seminomas tend to respond well to radiation treatment, while nonseminomas most often require chemotherapy or other treatment. Seminomas are also less likely to spread to the lungs, liver, and brain.
"Stage I" means that the cancer doesn't seem to have spread. Some stage I cancers actually have spread to the lymph nodes of the lower back but can't be seen.
Both types of cancer are very often cured, especially if they are found and treated early. Compared to other forms of cancer, testicular cancer—even when it has spread to other parts of the body—has a very high cure rate.
The first treatment is surgery to remove the testicle. After that, most men have three choices: surveillance, radiation, and chemotherapy.
Surveillance means that you are being watched closely by your doctor but are not having further treatment.
You have exams, chest X-rays, and blood tests regularly during the first few years, as well as CT scans. It can be hard to go to the doctor's office that often. Unless your cancer comes back, the number of checkups and tests will gradually decrease over the next 10 years.
With surveillance, you may be able to avoid the risks and side effects of radiation or chemotherapy. About 80 to 85 out of 100 men who choose surveillance are cured. They don't have to worry about future treatment. This means that about 15 to 20 of those 100 men do need treatment later.1
Even when cancer is found after a period of surveillance, it is usually possible to cure the cancer if it's found early. Because of this, many doctors consider it reasonable for some men to choose surveillance.
Radiation most often is focused on the lymph nodes in the pelvis and lower back, because that is where the cancer usually spreads.
When this cancer is found very early, it can be very hard to tell if these lymph nodes are cancerous. That's why radiation may be used even when no cancer can be seen.
Radiation and chemotherapy work about equally well for men with stage I seminoma.2
Chemotherapy is the use of very strong drugs to kill cancer cells. For men with stage I seminoma, chemotherapy may be used instead of radiation therapy. It is less toxic than radiation therapy and may work just as well to keep cancer from coming back.1
Your doctor can talk to you about which chemotherapy drugs have the least harmful side effects.
Perhaps the greatest risk of choosing surveillance has to do with missing your follow-up tests and exams. Without regular testing and checkups, you can miss cancer that has returned until it spreads beyond the lymph nodes and is harder to cure. If you choose surveillance, it's very important to strictly follow your doctor's schedule of tests and exams.
When cancer does come back during surveillance, it usually hasn't spread any farther than the lymph nodes in the lower back and pelvis. It can usually be treated successfully when the testing schedule has been followed closely.
Radiation treatment has side effects. Most (such as fatigue, nausea, vomiting, and diarrhea) are short-term. That means they go away when treatment is done. Other side effects can permanently affect your lifestyle and future health, but they aren't common. The most serious long-term risks from radiation include:
- Infertility. Radiation may cause permanent infertility in some men. Because many men diagnosed with testicular cancer are younger than 35, this can be an important issue. Men should bank their sperm before they have radiation treatment if they want to father children in the future. Talk to your doctor about any concerns you may have.
- Secondary cancer. Although radiation treatment is focused on cancer cells, it can also harm healthy cells. This sometimes leads to other cancers, such as leukemia, that show up many years later.
- Heart disease, such as heart attack.
Chemotherapy, often called chemo, for testicular cancer has caused permanent infertility in some men. Because most men diagnosed with this cancer are younger than 35, this is important to think about when you choose which treatment to use.
Men who are going to have this treatment should bank their sperm ahead of time if they want to father children in the future. Talk to your doctor about any fertility concerns you may have.
Side effects of chemo
Many men do not have problems with side effects from chemo. Other men have a great deal of trouble with them. If you have problems, your doctor can use other medicines to help you feel better.
Common side effects include:
- Nausea and vomiting.
- Hair thinning or hair loss.
- Mouth sores.
- An increased chance of bleeding and infection.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You have frequent checkups, X-rays, blood tests, and CT scans during the first few years.
- Surveillance works for many men. Out of every 100 men who try surveillance, about 85 remain free of cancer.3
- It can be hard to follow the long and intense schedule of checkups and tests that are required with surveillance.
- The cancer may be more likely to come back with surveillance.
- You have treatments at a hospital radiation department every weekday for a few weeks.
- Treatments take 10 to 15 minutes and are painless.
- Radiation and chemotherapy work about equally well for men with stage I seminoma.2
- Short-term side effects of radiation may include fatigue, nausea, vomiting, and diarrhea.
- Radiation can cause serious long-term health problems, including secondary cancers, but this isn't common.
- Radiation can cause infertility, but this isn't common.
- The chemotherapy drug is usually injected into a vein in your hand or arm. This method is called an IV.
- Treatment is most often done in a hospital.
- You have treatments for about 3 months.
- Chemotherapy works as well as radiation for stage I seminoma cancer.2
- Side effects of chemotherapy can include nausea and vomiting, hair loss, mouth sores, and diarrhea.
- Chemotherapy can cause infertility, but this isn't common.
Personal stories about choosing radiation therapy, chemotherapy, or surveillance for stage I seminoma
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
When I was a senior in high school, my doctor found a lump on my testicle during a physical. After doing some tests, he told me I had testicular cancer. I guess the good news was that we had found it early enough that it might not have spread yet. After surgery, my doctor looked at my test results and said that there was a good chance that orchiectomy by itself might cure me. I decided that I didn't want to go through with radiation or chemotherapy unless I absolutely had to, no matter how many checkups I had to go to. It's been about 3 years now, and so far the cancer has not come back. I still go in pretty often for exams and blood tests, but to me it's worth it. I think I made the right choice.
Stephen, age 20
About 6 months after our wedding, I discovered a lump on my testicles when I was in the shower. Needless to say, I was very concerned, and I scheduled an appointment with my doctor the next day. Within 3 weeks, I was having an orchiectomy. After that, my doctor said that my cancer was at an early stage and that I was very lucky to have found it because the lump wasn't very big. He told me that I could either have radiation therapy, chemotherapy, or wait and see if I was cured. I decided to wait and see. That was 2 years ago. Last week, my doctor found something on my CT scan that didn't look right. As it turns out, my cancer has come back. So now I'm going to have to have radiation therapy anyway. I wish I had just gotten it over with 2 years ago rather than going through all the checkups and tests, and worrying about it all this time.
Randall, age 29
Around 4 years ago, I found a lump on my testicles. After being diagnosed with early-stage seminoma testicular cancer, I decided to do chemo right away rather than radiation therapy or surveillance. My doctor told me that chemo doesn't carry the same risk of my getting another kind of cancer later in life. I know that there is still a small chance of being infertile from the chemotherapy. But to me it's an acceptable risk. My testicular cancer has been cured, and I feel great.
Adolfo, age 32
When I was 29, I was diagnosed with stage I seminoma testicular cancer. At the time, I was told that my cancer was found at a very early stage and that I could either choose radiation or surveillance after orchiectomy. I decided to go with radiation therapy, because I wanted my cancer to be cured as soon as possible. At the age of 46, I was diagnosed with leukemia, which my doctor says could be a result of the radiation therapy I received during treatment for testicular cancer. There's no way to be sure that that's what caused my leukemia. But now I wish I had thought about a surveillance program a little more seriously.
Jeff, age 49
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
I’m worried that if I have treatment, I may not be able to have children.
I’m willing to put up with the possibility of not having children if it means my cancer will be cured for good.
A long schedule of regular checkups and tests during surveillance will be worth it if it means I won’t need to have other treatment.
I don’t like the idea of chemotherapy.
I don’t like the idea of radiation treatment.
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT using surveillance
NOT having radiation treatment
NOT having chemotherapy
What else do you need to make your decision?
Check the facts
Which treatment means having checkups and tests often during the first few years?
- SurveillanceYou're right. Surveillance requires an intense schedule of frequent checkups and tests.
- RadiationSorry, that's wrong. It's surveillance that requires an intense schedule of frequent checkups and tests.
- ChemotherapySorry, that's wrong. It's surveillance that requires an intense schedule of frequent checkups and tests.
- I'm not sureIt may help to go back and read "What are the treatment choices for stage I seminoma testicular cancer?" Surveillance requires an intense schedule of frequent checkups and tests.
If you're worried that chemotherapy or surgery will leave you infertile, can you bank your sperm ahead of time?
- YesThat's right. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
- NoSorry, that's wrong. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
- I'm not sureIt may help to go back and read "What are the risks of chemotherapy?" If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Christopher G. Wood, MD, FACS - Urology, Oncology|
- National Comprehensive Cancer Network (2010). Testicular Cancer, version 2. Available online: http://www.nccn.org/professionals/physician_gls/PDF/testicular.pdf.
- National Cancer Institute (2011). Testicular Cancer Treatment PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional.
- Raghavan D, et al. (2007). Bladder, renal, and testicular cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 14. New York: WebMD.