Testicular Cancer Programs & Services

Our Testicular Cancer Services

Diagnosis

When you see BIDMC's testicular cancer experts, you may have a series of tests to thoroughly identify your condition and develop a treatment plan that works best for you. Some of these tests include:

Physical exam
Diagnostic imaging for the evaluation and staging of your disease, such as a CT scan or MRI to show detailed pictures of tissues and organs, as well as abnormal cells.
Biopsy – the removal of a tissue sample from the tumor. After removal of the testicular tumor, doctors can then tell what type of testicular cancer you have by looking at the cells under a microscope.
Blood tests – Some types of testicular cancer can increase blood levels of proteins known as tumor markers. For example, proteins including human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) can be detected by a simple blood test and are considered tumor markers for certain types of testicular cancer.

Treatment

Our genitourinary cancer team reviews all of your information during our weekly multidisciplinary conference. Radiologists report on your imaging studies and pathologists review the results of your biopsy. Urologists, oncologists, and radiation oncologists express their opinions. Then the team of experts considers all the options and chooses the best course of action for you. Depending on the type and stage of your cancer and other factors, testicular cancer treatment can include:

Surgery
Radiation therapy
Chemotherapy (chemo)

More than one of type of treatment might be used and, in general, the cure rates for testicular cancer are very high, usually over 95%.

Surgery for Testicular Cancer

Surgery is the first treatment for nearly all testicular cancers. In some cases, surgeons can perform it minimally invasively through very small skin incisions in the abdomen, which is called laparoscopic or robotic surgery. This usually means less blood loss during surgery and a quicker recovery time after surgery.

Radical inguinal orchiectomy

Surgery to remove a testicle with cancer is called a radical inguinal orchiectomy. A surgeon makes an incision in the lower abdomen and removes the entire tumor along with the testicle and spermatic cord. Men who are uncomfortable with their appearance after removal of a testicle can have a prosthesis (i.e., testis implant) placed in the scrotum, providing the look and feel of a real testicle.

Robotic- retroperitoneal lymph node dissection (R-RPLND)

Depending on the type and stage of your cancer, a second surgery might be recommended. This would involve removal of lymph nodes around the large blood vessels at the back of the abdomen. To preserve normal ejaculation, our surgeons are skilled in nerve-sparing surgical techniques that may avoid damage to the nerves surrounding retroperitoneal lymph nodes in some men. Traditionally, this surgery was done through a large abdomen incision. However, at BIDMC, we perform most of these surgeries using a robotic approach. We use several small laparoscopic incisions, which means patients usually have a much shorter overall recovery with this approach.

Possible side effects of testicular cancer surgery

Losing one testicle usually has no effect on a man's ability to get an erection and have sex. Because testicular surgery and chemotherapy may affect fertility, you may want to talk to your doctor about sperm banking. Sperm cells can be collected before cancer treatment and frozen for future use.

Therapies and Transplants for Testicular Cancer

Radiation Therapy

Radiation therapy is mainly used for patients with slow growing tumors (called seminomas). Sometimes it’s used after orchiectomy and is directed at the lymph nodes at the back of the abdomen. This is to kill any tiny bits of cancer in those lymph nodes that can’t be seen. It can also be used to treat small amounts of seminoma that have spread to the lymph nodes. Radiation is also sometimes used to treat testicular cancer that has spread to distant organs (like the brain).

Chemotherapy

Chemotherapy is sometimes used with surgical removal of the testicle to make sure all the cancer cells have been destroyed. For men with advanced tumors that have spread beyond the testicle or spread to distant areas of the body, chemotherapy is usually given for several weeks. Chemotherapy is given in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about three to four weeks.

Your team will talk with you about the medicines we recommend for you, how you'll receive them, what your treatment schedule will be like, and what to expect.

High-Dose Chemotherapy and Stem Cell Transplant

This is only offered to patients with very advanced cancer that is resistant to standard therapy. A stem cell transplant allows doctors to use higher doses of chemo. Stem cells used to be taken from the bone marrow, but this is done less often now. In the weeks before treatment, a special machine collects blood-forming stem cells from the patient's bloodstream. They are frozen and stored. The patient then gets high doses of chemo. After chemo, the patient gets his stem cells back through an infusion. This is called a transplant, but it doesn't involve surgery – the cells are infused into a vein much like a blood transfusion. The stem cells settle in the bone marrow and start making new blood cells over the next few weeks. Stem cell transplant is most often used to treat testicular cancers that have come back after treatment.