Just as crucial as the stage, i.e. the spread of the disease, is the tissue type of the tumor for the choice of treatment. A distinction is made between seminomas and non-seminomas. Sometimes a tumor has different proportions, namely seminomatous and nonseminomatous, but then it is always assigned to nonseminomatous tumors in terms of treatment.
Tissue type crucial for treatment of testicular cancer
Seminomas are very sensitive to radiation and are therefore treated primarily with radiation therapy. Only the diseased testicle is surgically removed. After that, there are two options for how to proceed, assuming the tumor was confined to the testicle only: It can either be irradiated immediately or one can wait to see if the disease progresses and only then irradiate. The chances of cure are the same for both treatment approaches.
Seminomas and non-seminomas
However, deciding which treatment is now right for which patient is not easy and always belongs in the hands of an experienced physician. If the tumor has spread to surrounding lymphatic wards, then radiation is always used. If the tumor has spread to more distant lymph nodes or even to organs or bones, chemotherapy is used in addition to radiation.
In the case of non-seminomas, radiotherapy does not play a role, as it does not have sufficient effect. Therefore, after surgical removal of the diseased testicle, the components of therapy in non-seminoma are chemotherapy and the so-called retroperitoneal lymph node resection. In this procedure, the lymph nodes in the abdomen are removed to eliminate, if possible, all cancer cells that may have spread in the lymphatic system.
Chemotherapy and lymph node removal may be used individually or in combination, depending on the stage and prognosis. However, similar to the treatment of seminoma, there are different treatment concepts for one and the same stage, which have different advantages and disadvantages with equally good prospects of success. Therefore, the same applies here: The decision belongs absolutely and exclusively in the hands of an experienced physician.
Follow-up care necessary for testicular cancer
After treatment has been completed, regular follow-up examinations must be performed so that renewed treatment can be initiated quickly if the tumor recurs. In principle, follow-up examinations include a physical examination, with particular attention always being paid to the remaining testicle, a blood test, and X-ray or computer tomography examinations.
The intervals at which the examinations are performed depend on how far the disease had originally progressed and which treatment was chosen. Normally, follow-up is completed after ten years.
Family planning not ruled out despite testicular cancer
Men who have testicular cancer can also have children later in life. This is because if only one testicle has been removed, the other is quite sufficient to father children. However, after completing cancer treatment with radiation and chemotherapy, doctors advise waiting at least two more years to have children until everything returns to normal.
However, all forms of cancer treatment, whether surgery, radiation or chemotherapy, carry the risk that this will disrupt the ability to conceive and will remain disrupted in the long term. For this reason, every man should decide before starting treatment whether he would like to have sperm preserved, i.e. frozen, as a precaution. Because only in this way can he have the certainty that offspring will be possible later in life, no matter what side effects the treatment may have had.
