Testicular cancer is staged by the surgeon based on the absence or presence of tumors outside the scrotal sac, whether the lungs or brain are involved and how much of the lymphatic system has been affected.
There are basically two types of testicular cancers – seminomas and nonseminomas. They both grow and spread at different rates and respond differently to the environment. Because of these differences the surgeon and oncologist must know what type of tumor that they are dealing with and the stage of the tumor.
Testicular cancer treatment without removal of the testicle is based on the stage and type of the tumor but in most cases the testicle requires removal. For instance it the testicular cancer is a stage I seminoma it is more usual to treat with surgical removal plus radiation aimed at the lymph nodes. Because these tumors are very sensitive to radiation lower doses can be used. More than 95% of the Stage I seminomas can be cured this way.
The follow up radiation is sometimes used later if further evaluation or follow up finds that the tumor has spread to the lymph nodes. At other times chemotherapy is used instead. But in either case the tumor is always removed.
The extent and type of removal may also differ based on the type of cells that comprise the testicular cancer tumor. In some instances only the tumor within the scrotal sac is removed and in other cases the surgeon may have to do a retroperitoneal lymph node dissection when they do the tumor removal by opening up the abdomen (stomach) and removing the testicle and some lymph nodes that drain that part of the reproductive system.
One of the biggest concerns that face men who must have a testicle removed to stop the spread of a cancer is that it will impair their fertility or sexual function. The good news is that the remaining testicle can produce enough sperm and hormones to maintain reproduction and sexuality.
Removal of the lymph nodes also doesn’t appear to affect the ability of the man to have erections or orgasms. On rare occasions the surgery can disrupt the nerve pathways that control the ejaculation which will result in problems with infertility. However, modern surgical techniques can spare the nerve innervations and increase the odds of retaining fertility.
If the man requires chemotherapy this treatment can increase the risk of infection, nausea and vomiting. But not all men experience these side effects. It is known that some of the chemotherapeutic drugs cause infertility but studies show that men recover their fertility in approximately 2-3 years after the therapy ends.
Cancer Research UK: Types of Treatment for Testicular Cancer
American Cancer Society: Testicular Cancer
National Cancer Insitute: Testicular Cancer Treatment Options by stage
Memorial Sloan Kettering Cancer Center: Testicular Cancer Treatment
James Buchanan Brady Urological Institute: Testicular Cancer Overview
Cancer.Net: Testicular Cancer
Cleveland Clinic: Understand your Treatment Options for Testicular Cancer
University of Chicago Medical Center Section of Urology: Testes Cancer
NHS Choices: Treating Testicular Cancer