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Treatment Options for Testicular Cancer by Stage

Learn about treatment options for different stages of testicular cancer in this Howcast video.

Transcript

When we talk about treatment for testicular cancer, there's various factors that we look at. We look at the stage of the disease, the type of testicular cancer you have, whether it's seminoma or non-seminoma. And we look at the status of your testicular tumor markers. These are proteins that are produced by testicular cancers in some cases. Now, Stage I testicular cancer is cancer that is confined to the testicle with no evidence of spread to the abdominal area or the chest area.

Stage I seminomas can be managed by removal of the testicle first, followed by either what we call surveillance, where we monitor things for you and make sure that there's no cancer recurrence; or, radiation therapy that would then be delivered to the area of the abdomen just in case there's presence of microscopic disease in the area of the abdomen. This will reduce the risk of recurrence in the area, and potentially treat cancers that have spread there. This is assuming that your testicular markers are normal.

If you have Stage I non-seminomas germ cell tumor, then the strategies are little bit different. We generally will offer surveillance, which is the monitoring protocol. We will offer a surgery to remove the lymph nodes in this area of the abdomen, to see if there's any spread of cancer there, and to provide what we call control of the retroperitoneum. Or we will offer two cycles of a chemotherapy regiment to treat any possible spread of cancer that may have occurred.

These three modalities are options only if your tumor markers are normal following removal of your testicle. If your tumor markers are not normal, meaning they are still elevated, then we generally will not do surgery. And then you would go on to have chemotherapy, with anywhere from two to four cycles, depending on what your medical oncologist recommends. But, in general, these are the options for Stage I testicular cancer.

Stage II testicular cancer is cancer that has spread to the abdominal cavity, to the lymph nodes in this area. And again, it depends on the extent of disease there. And also, whether you have seminoma or non-seminoma. If you have seminoma, then treatment options include radiation or chemotherapy. Again, that's determined by the extent of your disease.

If you have non-seminoma, then we have options of, again, surgery versus chemotherapy. And there, also, it depends on the extent of disease. The more extensive disease you have, the more likely you are to require chemotherapy. The less involvement you have, then surgery may also be an option. And there are pros and cons to each approach. But, this is done on a case by case basis, and it's important to discuss with your physicians what are the pros and cons of each of the approaches. Regardless, these therapies are also, again, done only if your tumor markers are normal. If your tumor markers are elevated, no matter what, then generally chemotherapy is given in most cases.

Stage III testicular cancer is a more extensive disease that's spread beyond the abdominal area to the chest or beyond. And in almost all of those cases, then we will proceed with chemotherapy at some point. And then we continue a monitoring protocol.

Now, one of the principles we use, after completion of chemotherapy for a non-seminomas germ cell tumor, following completion of chemotherapy, if there is residual cancer. Meaning there's still some nodules that are present on CT imaging, it is recommended to usually have those removed surgically, whether it's in the chest or in the abdominal area.

With seminoma, it becomes a little bit more tricky, and a little bit more complicated. That then becomes an issue of a case-by-case basis. We really have to look at some things in detail to figure out what the best option for you is. But in general, if there is residual disease after initial treatment with chemotherapy, there's always some risk that there could still be remaining cancer in that tissue.

There may be other things, like fibrosis, or scar tissue. There may be other types of tumors that are not exactly testicular cancer. Things such as teratomas. But in general, if there is residual disease following the administration of chemotherapy for any of these stages of cancer, then we often talk about potential additional therapies as necessary.

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