Treatment
The three most common forms of treatment for testicular cancer are surgery, chemotherapy, and radiotherapy (Kim et al., 2011; NCI, 2012; Pettersson et al., 2007). Which of these treatments will be used or in what combination will depend entirely on the type of testicular cancer, whether metastasis has occurred, and the discussions of the care team, including the surgeon, radiologist, and oncologist. The surgeon and the oncologist may well be the same person, and it must be noted that this care will frequently remain within the GUoncology team.
Seminomas have been found to be more sensitive to radiation, while the non-seminomas are more sensitive to chemotherapy (ACS, 2014a). Therefore, treatment, which is always aimed at affecting a cure, will be aimed at the type of cell involved. In those cases where both types of cells are present, the cancer will be treated as a non-seminomal cancer. The National Comprehensive Cancer Network (NCCN) has published the 2014 Clinical Practice Guidelines in Oncology, which has an extensive algorithm for use in the care of testicular cancers for both cell types of testicular cancer. Considerations are given to the stages of the cancer, whether recurrence occurs after a portion of the treatment has been completed, and whether residual masses are noted after the treatment has concluded.
Surgery is a frequent choice of treatment for localized testicular cancer. Because testicular cancer tends to be unilateral (Kim et al., 2011; NCI, 2014), this treatment allows the preservation of the remaining testis. However, evidence of surgery for metastatic disease affecting fertility issues was common knowledge prior to the 1990s, when a nerve-sparing technique and operative templates were devised for retroperitoneal lymph node dissection (RPLND) (Kim et al., 2011). This procedure can create an issue with fertility, as it can result in anejaculation.
Chemotherapy is frequently used as well, but multicenter studies have shown it is associated with cardiovascular, renal, neurological, and pulmonary ramifications in later years (Kim et al., 2011). Kim et al. (2011) found that chemotherapy seemed to create an increased risk for secondary cancers such as lymphoma and myeloid dysfunctions. The most frequent organ system to be affected with chemotherapy appeared to be the cardiovascular system, with Raynaud's disease the most frequent dysfunction; hypertension and high cholesterol levels have also been noted. However, Kim et al. (2011) stated that "chemo therapy-treated survivors were more significantly impacted as to quality of life" (p. 1630). Although these authors only studied those who had survived testicular cancer after having had these treatments, these modalities are used in almost all cancer treatment, and it has not yet been determined if those with testicular cancer are more at risk for these side effects in later life than those being treated for other cancer diagnoses.
Radiotherapy treatment was found to have a short-term effect on GI function, but that tended to decrease over time. However, solid tumor development in other organs was noted by Kim et al. (2011) to be increased later in life by those who had experienced radiotherapy as a treatment for testicular cancer.
The five-year survival rate is as high as 95% for those found in the first and second stages (ACS, 2014a; Porth & Matfin, 2009). Patients with more advanced stages have been known to have good outcomes with aggressive treatment and quality health care (ACS, 2014a; NCI, 2014; Porth & Matfin, 2009;). Given the occurrence of secondary tumor development, the need for continued medical follow up is important for survivors of testicular cancer.