The testicular cancer treatment depends on the type of testicular cancer (seminoma versus non-seminoma), stage of the disease, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of testicular germ cell tumor, but the final decision is taken after clinical assessment of the patient by an oncologist.
|Stage/TNM Score||Type||Preferred Treatment|
Tis N0 M0 S0
|Seminoma||Surveillance is generally preferred approach for patients with Stage 0 seminomas. The patient should be screened frequently for any sign of disease progression. No other treatment is generally recommended.|
T1-4 N0 M0 Sx
|Seminoma||In case of Stage I seminomas, high inguinal orchiectomy (complete removal of the affected testicle) followed by surveillance is the preferred option, mainly for T1-T3 disease. However, chemotherapy or radiation therapy is also an option after high inguinal orchiectomy.|
|Non-seminoma||In case of Stage I non-seminomas, high inguinal orchiectomy followed by surveillance is preferred for T1 disease. However, for T2-T4 tumors, chemotherapy or nerve-sparing retroperitoneal lymph node dissection (RPLND) are preferred after high inguinal orchiectomy.|
Any T N1-3 M0 Sx
|Seminoma||In case of Stage II seminomas, high inguinal orchiectomy followed by radiotherapy (for non-bulky disease or stage IIA) or chemotherapy (for bulky disease or stage IIB/IIC) is considered as the standard treatment.|
|Non-seminoma||In case of Stage II non-seminomas, high inguinal orchiectomy followed by RPLND (for non-bulky disease or stage IIA; with tumor marker(s) normal) or chemotherapy (for bulky disease or stage IIB/IIC, or tumor marker(s) elevated) is considered as the standard treatment.|
Any T Any N M1 Sx
|In case of Stage III seminomas and non-seminomas, radical inguinal orchiectomy followed by chemotherapy is the standard treatment. Radiation therapy and/or other palliative treatment may be given for relief of symptoms.|
Following is the brief description of various testicular cancer treatment:
1.Surgery: Mainly 2 types of surgeries are performed for testicular cancer treatment: High inguinal orchiectomy and retroperitoneal lymph node dissection (RPLND). In high inguinal orchiectomy, the affected testicle, spermatic cord, and associated blood and lymph vessels (that can provide passage for cancer spread) are removed. In RPLND, the cancer-containing lymph nodes in the abdomen (known as retroperitoneal lymph nodes surrounding the aorta and inferior vena cava) are removed. RPLND can be performed as an open surgery or as a laparoscopic procedure. Also, some patients may opt for sperm banking for fertility preservation before the surgery.
2.Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). Radiotherapy is generally recommended for seminoma it responds well to radiation. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.
3.Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for testicular germ cell tumor as it is a highly chemosensitive tumor. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.
It is very important to assess the benefits of each testicular cancer treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals for testicular cancer treatment:
-Prolongation of life.
-Reduction of symptoms.
-Improvement in quality of life.
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