In the vast majority of cases, the primary treatment option is to surgically remove the affected testicle (an orchidectomy) by a urological surgeon. This type of surgery is performed at UCLH.
Following this your case will be discussed at a multi-disciplinary team (MDT) meeting where your optimal treatment will be discussed.
You will have one follow up visit with your UCLH surgical team before having your care transferred to the oncology services at Barts Health NHS Trust for ongoing management and follow up.
An orchidectomy is the medical name for the surgical removal of a testicle. If you have testicular cancer, it is necessary to remove the whole testicle because only removing the tumour may lead to the cancer spreading. By removing the entire testicle, your chances of a full recovery are greatly improved. Your sex life and ability to father children should not be affected.
If you have testicular cancer that is detected in its very early stages, an orchidectomy may be the only treatment you require.
The operation is performed under general anaesthetic. A small incision (cut) is made in your groin and the whole testicle is removed through this incision. If you want, you can have an artificial (prosthetic) testicle inserted into your scrotum so that the appearance of your testicles is not greatly affected. The artificial testicle is usually made from silicone (a soft type of plastic).
Orchidectomy is usually performed as a day case although occasionally you will be expected to stay in overnight. If you only have one testicle removed, there should not be any lasting side effects.
Following an Orchidectomy, your medical team will give you advice on after care after leaving hospital and will answer any questions you may have. The advice below is helpful to follow when recovering from an Orchidectomy:
- Wound care – your surgeon will use dissolvable sutures (stitches) during your surgical procedure. You should try to keep this area dry and shower only for the first two weeks after surgery. Do not sit in a bath during this period.
- You should try and wear supportive underwear for the first two weeks following surgery, a scrotal support will be provided for you on leaving the ward.
- You may require 1-2 weeks off from work depending on your job.
- You must avoid any heavy lifting for four weeks following surgery.
Some treatments for testicular cancer can cause infertility. For some treatments, such as chemotherapy, infertility may be temporary.
Before your treatment begins, you may want to consider sperm banking. Sperm banking is where a sample of your sperm is frozen so that it can be used at a later date to impregnate your partner during artificial insemination. Before sperm banking, you will need to complete blood tests to check for infections such as HIV, Hep B and C.
At UCLH, we offer a free sperm banking service.
Those men who have undergone removal of one testicle are unlikely to require testosterone replacement therapy.
However, having both testicles removed will also stop you producing testosterone. This means you could experience a number of side effects including feelings of lethargy, fatigue, a low libido (a decreased sex drive) and find it more difficult to maintain an erection. In these circumstances, you will require testosterone replacement therapy.
Testosterone replacement therapy is where you are given a synthetic version of the testosterone hormone to compensate for the fact that your testicles will no longer produce the natural version.
Testosterone can be administered in a variety of ways including skin patches, gels and via an injectable. Your surgical team will discuss these options with you and recommend the appropriate course of treatment for your GP to commence.
Following your surgical treatment at UCLH you will be seen for on-going management and follow up at Barts Health NHS Trust.
Any further treatment, including chemotherapy and radiotherapy, will depend on two factors:
- whether you have a seminoma or a non-seminoma
- the stage of your cancer (see diagnosing testicular cancer for more information about staging)
In cases of stage one seminomas, after the testicle has been removed, a single dose of chemotherapy is usually given to help prevent the cancer returning. Sometimes a short course of radiotherapy is recommended.
In stage one non-seminomas, close follow-up (called surveillance) may be recommended, or a short course of chemotherapy using a combination of different medications.
In cases of stage two and stage three cancer, three to four cycles of chemotherapy are given using a combination of different medications. Further surgery may sometimes be needed after chemotherapy to remove any affected lymph nodes.
A similar treatment plan is used to treat stage four cancer. Additional surgery may also be required to remove tumours from other parts of the body, depending on the extent of the spread of the tumour.
After your surgical care at UCLH you may be offered any of the following treatments. Your clinical team at Barts Health NHS Trust will discuss your options in detail with you.
Chemotherapy uses anti-cancer medicines to kill the malignant (cancerous) cells in your body or stop them multiplying.
If you have advanced testicular cancer or it has spread within your body, you may require chemotherapy. It is also used to help prevent the cancer returning. Chemotherapy is most commonly used to treat non-seminoma tumours.
Radiotherapy uses high-energy beams of radiation to help destroy cancer cells. Sometimes, seminomas may require radiotherapy after surgery, to help prevent the cancer from returning.
If your testicular cancer has spread to your lymph nodes, you may require radiotherapy after a course of chemotherapy.
If your testicular cancer is more advanced, it may spread to your lymph nodes which will need to be removed. Your lymph nodes are part of your body's immune system, which help to protect it against illness and infection.
Lymph node surgery can include a new type of lymph node surgery, called nerve sparing retroperitoneal lymph node dissection (RPLND), and a new type of ‘keyhole’ surgery called laparoscopic retroperitoneal lymph node dissection.
Please see the NHS website for further information on these procedures.