Just as crucial as the stage, ie the spread of the disease, is the tissue type of the tumor for the choice of treatment. Differences between seminomas and non-seminarians. Sometimes a tumor has different parts, namely seminous and non-seminous, but then it is always assigned to non-seminous tumors by treatment.
Tissue type crucial for treatment of testicular cancer
Seminomas are very sensitive to radiation and are therefore treated primarily with radiotherapy. Only the diseased testicles are surgically removed. Thereafter, there are two ways to proceed, provided that the tumor was limited to the testes only: it can either be irradiated immediately or it can be seen whether the disease progresses and then irradiate. The chances of recovery are the same for both treatment concepts.
Seminomen and non-seminomas
However, the decision as to which treatment is right for which patient is not easy and always belongs in the hands of an experienced doctor. If the tumor has spread to the surrounding lymphatic stations, it is always irradiated. If the tumor has penetrated into more distant lymph nodes or even into organs or bones, chemotherapy is used in addition to the radiation.
In non-seminomas radiotherapy does not matter because it does not show sufficient effect. Therefore, the therapeutic components of non-seminoma after surgical removal of the diseased testicle are chemotherapy and the so-called retroperitoneal lymph node resection. In this procedure, the lymph nodes in the abdomen are removed to eliminate as much as possible of 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. Here too, 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 chances of success. Therefore, here too, the decision is unconditionally and exclusively in the hands of an experienced doctor.
Aftercare for testicular cancer necessary
After treatment is complete, regular follow-up examinations should be carried out to quickly re-initiate treatment if the tumor re-emerges. In principle, the follow-up examinations include a physical examination, whereby special attention must always be paid to the remaining testes, a blood test and X-ray or computed tomography examinations.
The intervals at which the controls are performed depend on how far the disease had originally progressed and which treatment was chosen. Usually the aftercare is completed after ten years.
Family planning despite testicular cancer is not excluded
Men who have testicular cancer can also have children later in life. Because if only one testicle was removed, the other is enough to give birth to children. However, after completing cancer treatment with radiation and chemotherapy, the doctors recommend waiting at least two more years with the offspring until everything has returned to normal.
However, all forms of cancer treatment, including surgery, radiation or chemotherapy, carry the risk of disrupting fertility and of long-term dysfunction. Therefore, every man should decide before the start of the treatment, whether he does not want to preserve sperm for safety, so would like to freeze. Because only then can he have the certainty that in later life offspring is possible, no matter what side effects the treatment may have had.
Tumor Center Munich
Robert Koch Institute
Guideline for the diagnosis and therapy of testicular tumors of the German Society of Urology