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• Types of Cancer
• Testicular Cancer
• Am I at risk?
• Can I get screened?
• How do you diagnose it?
• What are the Symptoms of Testicular Cancer?
• What are the treatment options?
• What is Testicular Cancer?

Testicular cancer is among the most curable of all cancers. For early-stage cancers, the survival rate is approximately 95 percent. Even with advanced testicular cancer, patients tend to respond well to treatment, and the prognosis is very good for most patients. Treatments are based on the stage of the cancer at time of diagnosis, as well as the particular type (seminoma or nonseminoma). Your physician will recommend an individualized treatment plan that may include surgery, radiation therapy, or chemotherapy, or several of these options used in tandem. The use of multiple treatments is known as combined modality therapy.

Surgical Procedures

The surgical removal of the cancerous testicle is always the first step in treatment for testicular cancer. Following surgery, many patients - particularly those with seminomas - will undergo radiation therapy. For more advanced cancers, postoperative chemotherapy may be administered as well. The postoperative administration of radiation and/or chemotherapy is known as adjuvant therapy.

The main surgical procedures for testicular cancer are:

Orchiectomy (also known as radical inguinal orchiectomy) is surgical removal of the affected testicle and spermatic cord. The surgeon removes the testicle through an inguinal (groin area) incision rather than the scrotum, to reduce the risk of spreading cancer through the loose skin of the scrotum. The unaffected testicle is not removed, because the risk of cancer development is very low. This ensures maintenance of adequate levels of male hormones and preservation of fertility.

If the cancer has spread to lymph nodes, a procedure known as Retroperitoneal Lymph Node Dissection (RPLND) may be performed to remove lymph nodes in the pelvis and lower abdomen. A longer, more complex procedure than orchiectomy, RPLND is typically done at a later date.

Even when one testicle is still present after orchiectomy, traditional RPLND can potentially result in infertility because it may interfere with the nerves involved in ejaculation. An exciting new nerve-sparing technique is now available at John Muir Health for appropriate patients undergoing RPLND. The objective of this technique is to help preserve ejaculatory function by sparing the associated nerve bundles during lymph node removal. The surgeon carefully cuts cancerous tissue away from these bundles without damaging them. Nerve-sparing RPLND is not an option for all patients, since the nerves must sometimes be sacrificed to ensure that all cancerous tissue has been removed.

Chemotherapy

Chemotherapy - or the use of drugs that kill cancer - is sometimes used after surgery for patients with advanced testicular cancer. Even for patients with metastatic cancer, the response rate to combined chemotherapy and surgery tends to be fairly high. Patients may receive a single chemotherapy drug, or multiple drugs used in combination. Through its active research program, with regional and national affiliations, John Muir Health can also provide patients with access to investigational chemotherapy agents.

Radiation Therapy

Radiation therapy is often used after surgical removal of the cancerous testicle to eradicate any remaining cancer cells, and to help prevent cancer recurrence. Postoperative radiation therapy is known as adjuvant therapy. Seminomas typically are highly responsive to radiation therapy, and require lower doses of radiation than other cancers. Lymph nodes in the abdomen, chest and neck may be radiation targets. The type of radiation therapy used in testicular cancer is external beam radiation, in which the affected area is radiated from outside the body via a precisely targeted beam of radiation from special equipment called a linear accelerator. Before radiation therapy, patients may be given radiosensitizing chemotherapy drugs, which help to enhance the cancer-killing efficiency of radiation.

John Muir Health is one of northern California's premier centers for radiation therapy, with a reputation for clinical excellence and cutting-edge technology. Our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners to ensure the most precise and effective radiation therapy available. The advanced radiation therapy capabilities at John Muir Health include:

• Three-Dimensional Conformal Treatment - This sophisticated form of external beam therapy uses a computerized treatment planning system that optimizes radiation therapy by pinpointing the location of the tumor with the highest level of precision possible. This capability is very important in planning the most effective therapies for testicular cancer. Special features on the linear accelerator called multi-leaf collimators enable the radiation beam to be "shaped" to closely conform to the contours of the tumor. This permits a higher dose of radiation to be administered directly to the target area, while diminishing the radiation dose to surrounding tissue, thereby increasing cancer-killing effectiveness while minimizing toxicity.
• Intensity-Modulated Radiation Therapy (IMRT) is a newly introduced enhancement of the technology used in three-dimensional conformal therapy. Specialized treatment planning software is used to development a precise plan that "modulates" or varies the radiation used in each treatment session. The highest possible doses of radiation can be applied directly to the target areas, while lower doses are applied to areas adjacent to organs and critical structures that need to be protected.

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