For more information about testicular cancer symptoms, diagnosis, treatment, and support, visit http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Testicular-Cancer.aspx.
Dr. Clair Beard, Director of the Testicular Cancer Program at Dana-Farber/Brigham and Women's Cancer Center, describes treatment options for men diagnosed with testicular cancer.
Stage 1 testicular cancer implies that there is only cancer in the testicle, and now the testicle has been removed. You've had your blood tests, your tumor markers, and there’s no sign of any tumor marker elevation after the testicle has been removed. You’ve had a chest X-ray, a chest CT; there’s no sign of tumor in the test. And you've had an abdomen and pelvis CT scan, and there’s no sign of tumor in the abdomen. So, you have a stage 1 tumor.
So now, you have choices. One choice is to have monitoring—we call this ‘active surveillance’—and that means no more treatment, just monitoring. With active surveillance, we don’t treat anybody unless they relapse, and the chance of relapse is dependent upon what kind of cancer was actually in the testicle. If you had a seminoma, your chance of relapse is between 10% and 15%. With certain kinds of non-seminoma, the chance of relapse can be as low as 10% and as high as 50%, so the monitoring schedule that we set up for you is dependent upon the kind of testicular cancer you have. You might have a CAT scan as infrequently as every six months or as frequently as every three months—it depends on, again, the histology.
Then what happens is you come in for your CAT scan, however often as necessary. You come in and the CAT scan is negative; you go home and wait until your next CAT scan appointment. And then if your CAT scans are free and clear, you never have to have treatment. If at any time something shows up on the CAT scan, then—and only then—do you receive treatment.
Then the treatment depends on what shows up. If you have a seminoma and a small lymph node shows up at some point on your CAT scan, well then you can have a course of low-dose radiotherapy. If you have a non-seminoma and a lymph node shows up, you might have some chemotherapy.
Now, for some patients—particularly with non-seminoma—you might think, ‘Well, I don’t know if I want to come in every three months for a CAT scan, or every four months for a CAT scan. I might want treatment now—this makes me nervous.’ Well, you might choose to have one cycle of three kinds of chemotherapy, and this is very effective treatment. That decreases your risk of recurrence from 50% down to less than 5%. So, for some patients that’s an option, and our medical oncologist would discuss that with you.
The important thing to understand when you have stage 1 testicular cancer is whether you choose for upfront treatment or you choose to be monitored, the cure is exactly the same—it’s almost 100% either way, so patients do really well with stage 1 testicular cancer.
Stage 2 testicular cancer implies that you have some tumor in the upper abdomen. When testicular cancer spreads, it spreads first to the upper abdomen—not to the lymph nodes near the testicular—but actually the lymphs nodes near the kidneys. For those patients, treatment can be low-dose radiotherapy for seminoma patients, and pretty much everybody else it’s chemotherapy.
Typically what happens is patients get three or four cycles of chemotherapy, and a cycle is a grouping of chemotherapy typically given over three weeks. They get their CAT scans after the chemotherapy is completed. They go into complete remission, and then they're monitored in the months and years that follow chemotherapy.
Again, cure rates are very, very high. Patients do very well. It’s important if you choose to have treatment for your stage 2 testicular cancer to receive treatment with someone who understands how to treat testicular cancer. Testicular cancer is rare. It’s a little bit tricky to treat, so it’s important to have someone who knows how to treat testicular cancer properly.
For stages 3 and 4 testicular cancer, the treatments are more elaborate. Typically you're receiving more than just three cycles of chemotherapy. Sometimes surgery is necessary. Sometimes salvage chemotherapy is necessary—these are different kinds of chemotherapy. Sometimes high-dose chemotherapy is necessary. These are all specialty treatments that need to be given at a high-volume specialty center, like Dana-Farber.