Treatment

Surgical treatment

Removal of the testicle is an operation that is carried out by cutting the skin of the scrotum or removing the testicle with the appendix, the seminal vesicle. The operation can be performed either under general anaesthesia (complete sleep) or under spinal anaesthesia (injection of medication into the spinal cord), which removes the sensations in the lower part of the body. Local anaesthesia is also available. It is important to know that one remaining testicle is sufficient for normal sexual life and fertilisation.

Chemotherapy

If necessary, the doctor prescribes drugs that act on the cancer cells. Usually, several drugs are given according to certain schedules. They may be given intravenously, intramuscularly. These medicines stop the cancer cells from multiplying, developing and growing.

Radiotherapy treatment

Depending on the number of cells found in the affected testicle, radioactive treatment may be prescribed. Special machines containing radioactive elements will be used to irradiate specific areas of the body according to a plan drawn up by the radiotherapist. Usually, the course of treatment lasts for 10 to 20 sessions. Different parts of the body can be irradiated: groin, lower or upper abdomen, chest. This depends on the lesions found.

Effects on the development of secondary malignancies

Researchers are investigating the impact of chemotherapy and radiotherapy treatment on the development of other tumours, i.e. secondary malignancies. The risk of developing other malignancies in the future is thought to be small. Modern chemotherapy and radiotherapy significantly reduce the chance of secondary tumours compared to previous treatments for testicular cancer. However, the researchers report that the risk of developing another malignancy increases by a factor of 2-3 for patients who have received chemotherapy and/or radiotherapy.

Fertility

This is a sensitive issue for testicular cancer patients. In these patients, sperm production is sometimes already reduced before treatment. Before starting treatment, the patient should know whether there is enough sperm now, what the treatment will be, whether it will be radiotherapy or chemotherapy, how long the treatment will last, and whether the surgeon will be able to preserve the nerves responsible for ejaculation during the operation. A decrease in sperm count during the treatment itself does not necessarily mean that the man will be infertile after the treatment - sperm counts increase again over time. But for those who had less sperm before treatment, there may still not be enough sperm over time, so these patients should, if possible, have their sperm stored in a sperm bank before treatment. Consultation with an andrologist is advisable in this respect.

Effect on testosterone production

If the disease and treatment reduce the amount of sperm produced, it is possible that testosterone levels will also be insufficient. In such cases, patients need to take testosterone replacement therapy - to supplement the testosterone deficiency they are given testosterone preparations.

Treatment in case of recurrence

In the case of recurrence in the lymph nodes of the infiltrate, chemotherapy alone may be sufficient; if there are residual tumours in the infiltrate or in other areas after chemotherapy, surgical removal may be used.