Chemotherapy is a form of therapy for cancer where medications are infused through IVs into the body to help kill cancer cells. With many types of chemotherapy and for a testicular cancer we use certain types of chemotherapy. Not everybody with testicular cancer will require chemotherapy, but in general, situations that may use chemotherapy would involve cases where testicular cancer has spread to different parts of the body. Most commonly the abdominal area or the chest. However, if there is spread of cancer to those sites then we may refer you to a medical oncologist.
These are doctors who deliver chemotherapy for the purpose of curing the disease. Chemotherapy is highly effective for certain types of testicular cancers and is delivered over a course of several cycles. Then the medical oncologist will counsel you on the various types of chemotherapy, the risks associated with those types of chemotherapy. Most common situations where we would use chemotherapy would be situations where you may have what's called a non-seminomatous tumor. Which is one category of testicular cancer where that cancer has spread to the abdominal region.
Even in cases where the cancer has not spread to the abdominal cavity or elsewhere, then we may look at certain features of the cancer within the testicle. If we see certain features like lymphovascular invasion, that may increase the risk that there may even be microscopic disease elsewhere in the body. Or if we see evidence of certain types of aggressive forms of cancer within the testicle, like embryonal carcinoma, which is one variant of non-seminosal (sp) tumor. In those cases, we may also offer chemotherapy. In general, whenever there is spread of cancer to other areas then we do consider chemotherapy as an option. But even when there is no spread of cancer to those areas, we may offer it to patients.
Other options in those situations would include things like surveillance. Where we continue to monitor things to make sure that the patient does no develop cancer elsewhere or surgery in the form of what we call a retroperitoneal lymph node deception. This is a procedure that is done to remove the lymph nodes in the abdominal area to make sure there is no cancer that is present there. So, in some cases we would talk to patients about surveillance versus surgery by retroperitoneal deceptions versus chemotherapy.
It all depends on what type of cancer you have, the stage of cancer you have, the extent of cancer you have, and also what happens to, what we call, testicular tumor markers. Testicular tumor markers are proteins produced by the testicular cancer. When they are elevated they generally signify the persistence or presence of viable testicular cancer. In many cases where patients have persistent elevation of their tumor markers, even after removal of the testicle, whether or not there is presence of cancer that's visible on a CT scan, we would recommend that patients in that situation undergo chemotherapy. There are many factors that we look at, but these are some of the general principles and concepts that we use to treat testicular cancer.