Observation
Observation can be done in cases that are Stage I and have any tumor type. Since testicular cancers can have rapid growth, close monitoring with frequent blood tests, CT scans and chest X-rays is required. Patients who choose observation run a 20 to 30 percent chance of having a recurrence. The surveillance regimen is quite rigorous with blood tests and chest X-rays every month and CT scans every three months for two years. The obvious advantage to this approach is that the patient avoids additional, potentially morbid treatment. The big disadvantage is that roughly one in four is likely to need additional treatment, and that treatment would be delayed because the tumor metastasis would have been present at the time of the removal of the testicle.

Radiation Therapy
Adjuvant radiation therapy is delivered to the retroperitoneal lymph nodes in patients who have Stage I seminoma. This treatment takes about two weeks to complete and is well tolerated. Patients may experience fatigue and some upset in bowel activity. Potential long-term side effects may include development of secondary malignancies, such as retroperitoneal sarcomas, and an increased incidence of cardiovascular disease.

Chemotherapy
Chemotherapy is the treatment regimen for patients with advanced cancer. It generally is given as a combination of three drugs, the most important of which is cis-platinum. Bleomycin and etoposide are the two other drugs that make up the combination. Regimens may consist of two to four cycles of the drugs administered roughly one month apart. Each cycle takes about three weeks to complete. The first week is the most intensive, with five days of intravenous infusions of cis-platinum. The patient also is given etoposide and bleomycin during the first week. During the second and third weeks, the patient receives only one dose of bleomycin each week. Toxic effects include nerve, kidney, heart and lung damage. There also is a risk of infection.

In patients with Stage I disease, some centers offer a two-cycle chemotherapy regimen, although this is more commonly done in Europe. Patients with documented lymph node positive disease in the retroperitoneum after retroperitoneal lymph node dissection often receive three to four cycles of chemotherapy.

Retroperitoneal Lymph Node Dissection
Patients with low stage (Stage I or Stage II), non-seminomatous tumors often elect to undergo further surgery to remove the lymph nodes in the retroperitoneum. Retroperitoneal lymph node dissection (RPLND) is both diagnostic and therapeutic.

This surgery commonly is performed as an open procedure with an incision extending from the breastbone to the pubic bone at many centers.

Washington University School of Medicine is a leader in minimally invasive surgery. We employ laparoscopic surgical techniques for RPLND, performing the exact dissection and removal of the lymph nodes that is done as an open surgical procedure. Click here to learn more about laparoscopic RPLND.

Learn more about Siteman Cancer Center's treatment of testicular cancer.

Washington University physicians are the medical staff of
Barnes-Jewish Hospital and St. Louis Children's Hospital