Chemotherapy for testicular cancer

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Some people with testicular cancer have chemotherapy. If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

You may have chemotherapy to:

• shrink a tumour before other treatments such as a retroperitoneal lymph node dissection (RPLND)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (called adjuvant chemotherapy)
• treat testicular cancer that comes back after being treated
• relieve pain or control the symptoms of advanced testicular cancer (called palliative chemotherapy)

A combination of chemotherapy drugs is usually used to treat testicular cancer. The most common chemotherapy combinations used for testicular cancer are:

• BEP – bleomycin, etoposide and cisplatin
• EP – etoposide and cisplatin
• VIP – etoposide, ifosfamide and cisplatin

EP and VIP are used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage.

Stage 1 seminoma may be treated with a single chemotherapy drug (carboplatin) after you have surgery to remove the testicle (called a radical inguinal orchiectomy, or an orchiectomy). The goal is to prevent the cancer from coming back.

If testicular cancer doesn’t respond to drugs in earlier treatments or if the cancer comes back, you may be given another chemotherapy combination (called salvage chemotherapy). You may be offered one of the following combinations:

• TIP – paclitaxel, ifosfamide and cisplatin
• VIP – etoposide, ifosfamide and cisplatin
• VeIP – vinblastine, ifosfamide and cisplatin

Almost all chemotherapy drugs for testicular cancer are given through a needle into a vein (intravenously). Some drugs may be given as an injection or by mouth (orally).

A higher dose of chemotherapy (called high-dose chemotherapy) with carboplatin and etoposide may be used if testicular cancer comes back after it is treated with standard-dose chemotherapy. After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that were damaged or destroyed by high-dose chemotherapy. The stem cell transplant uses stem cells from your own blood (called an autologous peripheral blood stem cell transplant). The stem cells are collected from your blood before high-dose chemotherapy.

Palliative chemotherapy is given to relieve symptoms and extend your life, rather than to treat the cancer itself. Gemcitabine may be given with oxaliplatin, paclitaxel or both as palliative treatment for seminomas or non-seminomas. Etoposide taken by mouth (orally) is also an option for palliative chemotherapy.

Side effects of chemotherapy will depend mainly on the drug, the dose, how itʼs given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects of chemotherapy drugs for testicular cancer include:

• nausea and vomiting
• low blood cell counts
• sore mouth and throat
• loss of appetite and weight loss
• diarrhea
• hair loss
• fertility problems and sexual problems
• bladder problems
• kidney problems
• lung problems
• nervous system problems, such as numbness or tingling of the hands and feet (called peripheral neuropathy), hearing damage and erectile dysfunction
• fatigue
• heart problems, such as high blood pressure and high blood cholesterol levels (called metabolic syndrome)
• a second cancer, such as leukemia

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.