When we talk about treatment for testicular cancer, there's various factors
that we look at.
We look at the stage of the disease, the type of
testicular cancer you have, whether it's seminoma or non-seminoma.
And we look at the status of your testicular tumor
markers.
These are proteins that are produced by testicular cancers in
some cases.
Now, Stage I testicular cancer is cancer that is confined
to the testicle with no evidence of spread to the abdominal area or
the chest area.
Stage I seminomas can be managed by removal of the testicle first, followed
by either what we call surveillance, where we monitor things for you and
make sure that there's no cancer recurrence; or, radiation therapy that
would then be delivered to the area of the abdomen just in case there's
presence of microscopic disease in the area of the abdomen.
This will reduce the risk of recurrence in the area,
and potentially treat cancers that have spread there.
This is assuming that your testicular markers are
normal.
If you have Stage I non-seminomas germ cell tumor, then the strategies are
little bit different.
We generally will offer surveillance, which is the
monitoring protocol.
We will offer a surgery to remove the lymph nodes in
this area of the abdomen, to see if there's any spread of cancer there, and
to provide what we call control of the retroperitoneum.
Or we will offer two cycles of a chemotherapy regiment to treat
any possible spread of cancer that may have occurred.
These three modalities are options only if your tumor markers are normal
following removal of your testicle.
If your tumor markers are not normal, meaning they are still elevated, then we generally
will not do surgery.
And then you would go on to have chemotherapy,
with anywhere from two to four cycles, depending on what your medical oncologist
recommends.
But, in general, these are the options for Stage I
testicular cancer.
Stage II testicular cancer is cancer that has spread to the abdominal
cavity, to the lymph nodes in this area.
And again, it depends on the extent of disease there.
And also, whether you have seminoma or non- seminoma.
If you have seminoma, then treatment options include radiation or
chemotherapy.
Again, that's determined by the extent of your disease.
If you have non-seminoma, then we have options of, again, surgery versus
chemotherapy.
And there, also, it depends on the extent of disease.
The more extensive disease you have, the more
likely you are to require chemotherapy.
The less involvement you have, then surgery may also be an
option.
And there are pros and cons to each approach.
But, this is done on a case by case basis, and it's important to
discuss with your physicians what are the pros and cons of each of the
approaches.
Regardless, these therapies are also, again, done only if your
tumor markers are normal.
If your tumor markers are elevated, no matter
what, then generally chemotherapy is given in most cases.
Stage III testicular cancer is a more extensive disease that's spread
beyond the abdominal area to the chest or beyond.
And in almost all of those cases, then we will proceed with chemotherapy
at some point.
And then we continue a monitoring protocol.
Now, one of the principles we use, after completion of chemotherapy for a
non-seminomas germ cell tumor, following completion of chemotherapy, if
there is residual cancer.
Meaning there's still some nodules that are present on CT imaging, it is recommended to
usually have those removed surgically, whether it's in the chest or in
the abdominal area.
With seminoma, it becomes a little bit more tricky, and a little bit more
complicated.
That then becomes an issue of a case-by-case basis.
We really have to look at some things in detail to figure
out what the best option for you is.
But in general, if there is residual disease after initial
treatment with chemotherapy, there's always some risk that there could
still be remaining cancer in that tissue.
There may be other things, like fibrosis, or scar tissue.
There may be other types of tumors that are not exactly
testicular cancer.
Things such as teratomas.
But in general, if there is residual disease following the
administration of chemotherapy for any of these stages of cancer, then we
often talk about potential additional therapies as necessary.