Testicular cancer develops as a result of irrepressible growth of cells on or within one or both testicles/testes. Once testicle cancer diagnosis and staging have been done, the team of oncologists would suggest varied treatment choices based on the patient’s overall physical health.
Treatment Options For Testicular Cancer
Testicle cancer is of 2 key forms, namely, nonseminoma germ-cell tumors (NSGCT) and seminoma which can be cured when early diagnosis and therapy is commenced. Nonseminoma germ-cell tumors have a tendency of developing resistance to radiotherapy as compared to seminomas and additionally have a greater likelihood of distant metastasis.
Testicle Cancer treatment choices for these types of testicle cancer that haven’t metastasized past the testes are surgery, chemotherapy, radiotherapy and wait-and-watch/surveillance.
Radical Inguinal Orchiectomy
Preliminary treatment initiates with radical inguinal orchiectomy whenever the doctor suspects testicle cancer as lumps in this region are mostly malignant and their removal is essential. Moreover, conducting biopsy on the testis prior to operative removal could lead to cancerous cells spreading out which can hinder therapy success.
Orchiectomy is an operative procedure wherein the physician removes the testis via a smallish slit made in the groin. Unilateral (single testis removal) or Bilateral (right and left testis removal) Orchiectomy is at times the sole therapy necessary for several people with preliminary stage testicle cancer ensued merely by wait-and-watch approach. This is crucial for successfully treating the condition and provides the best likelihood of being cured.
After orchiectomy, patients with initial stage nonseminoma germ-cell tumors generally undergo further surgery, chemotherapy or surveillance, though atypically are offered radiotherapy.
Retroperitoneal Lymph Node Dissection (RLND)
When testicle cancer predictably metastasizes via the lymph nodes upward and outwards to organs like lungs, brain, liver and other areas then cancerous lymph nodes are termed as retroperitoneal lymph nodes. Retroperitoneal lymph node dissection is an invasive procedure conducted for stage II and above cases to remove malignant lymph nodes that are often located behind crucial organs in the abdomen. Either a large slit is made for removal or laparoscopic surgery is performed wherein a fine, bendable laparoscope is passed through tiny slits made in the abdomen for removing affected lymph nodes. Laparoscopic surgery is commonly performed for people having initial staging non-seminoma to check whether lymph nodes are cancerous.
In the initial phases of stage I non-seminoma testicle cancer it could be rather tricky to know if such lymph nodes are malignant sans operative removal. Hence, chemotherapy is often recommended among people where the lymph nodes on removal have cancer.
Chemotherapy involves the usage of potent drugs (oral, intravenous/intramuscular course) for annihilating cancerous cells. The medicines on gaining entry into the blood are capable of reaching all through the body and killing cancerous cells.
It is mostly the line of treatment for testicle cancer that has metastasized beyond the testis or for reducing the chances of cancer recurrence following testis removal.
Chemotherapy is offered in cycles lasting around 21 days to a month with a resting period in between each one. Generally, dual drug course is chiefly used for increasing effectiveness which comprise of Etoposide, Vinblastine, Paclitaxel, Ifosfamide, Cisplatin, Cyclophosphamide, Bleomycin. Some of the regimes deployed in preliminary therapy include Cisplatin in conjunct with only Etoposide or including a third drug, Bleomycin.
Autologous Stem Cell Transplant
When testicle cancer has recurred and other treatments fail then high-dosage chemotherapy with autologous stem cell transplant could occasionally be offered.
The patient’s blood is withdrawn and preserved prior to undergoing radiotherapy and chemotherapy which will then kill the sickly cells present in the bone marrow as well as throughout the body. The preserved blood is then transferred back to the patient through a central venous catheter placed in the chest. This assists the bone marrow in working right and manufacturing novel blood cells within 7-21 days.
Sometimes, radiotherapy is suggested along with chemotherapy once surgery is done for treating advanced staging of this condition.
In this treatment, delivery of high energy beam of appropriate dosage is meticulously done from a device positioned away from the body. It is a pain-free, brief procedure chiefly for people having seminoma testicle cancer that has high sensitivity to it, though it appears to be effective even for nonseminoma germ-cell tumors. Radiotherapy is at times done after operative testicular removal and aimed at the cancerous lymph nodes for obliterating remnant cancer.
It is also termed as watchful waiting and patients don’t receive active therapy like chemotherapy, radiotherapy or surgery. However, they are monitored through chest and physical examinations coupled with blood analysis performed every month for the initial year along with a CAT scanning procedure conducted in three-monthly period. When recurrence isn’t detected then these examinations would lessen in frequency to around once every year after half a decade subsequent to orchiectomy. In case cancer recurs then it is treated accordingly. This is often chosen by several patients having seminoma and non-seminoma germ-cell tumors.
All treatment options have their associated side-effects and oncologists would offer relevant information about the same so that patients are well-informed prior to arriving at any decision about their treatments.