Treatments for seminoma

The following are treatment options for the different stages of seminoma testicular cancer. The treatments you are offered depend on the stage and the prognosis group. If cancer comes back (recurs), the treatments offered will depend on the treatments that were used for the original cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Seminoma testicular cancer can often be treated successfully, even when it is at a later stage.

Surgery is the first treatment for stage 1 seminoma. The testicle and spermatic cord are removed through a small opening in the groin. This is called a radical inguinal orchiectomy, or it can also simply be called an orchiectomy. It’s usually done as part of the diagnosis.

Active surveillance is the preferred management after surgery for stage 1 seminoma. It involves regular and frequent follow-up to look for signs and symptoms that the cancer has come back. Tests done during follow-up visits include a physical exam, blood tests to check tumour marker levels and imaging tests (such as CT scans and sometimes chest x-rays). Other treatments such as radiation or chemotherapy are offered if you develop signs or symptoms that the cancer has come back.

Surgery, followed by active surveillance, is often the only treatment that people with stage 1 seminoma need.

Radiation therapy may be offered in rare cases after surgery for stage 1 seminoma to reduce the risk of recurrence. Radiation is directed at the lymph nodes in the back of the abdomen (the retroperitoneum). It is sometimes given to the lymph nodes in the pelvis as well.

Chemotherapy may be offered in rare cases after surgery for stage 1 seminoma to reduce the risk of recurrence. Carboplatin given through a needle in a vein (intravenously) is the most common type of chemotherapy for stage 1 seminoma.

Find out more about surgery, active surveillance, radiation therapy and chemotherapy for testicular cancer.

Surgery is the first treatment for stage 2 seminoma. An orchiectomy is done.

Active surveillance may be offered for stage 2 seminoma after surgery if tumour marker levels are normal.

Radiation therapy may be offered after surgery for stage 2 seminoma. Radiation is directed at the lymph nodes in the back of the abdomen and in the pelvis.

Chemotherapy may be offered after surgery for stage 2 seminoma. Chemotherapy may also be used if the cancer comes back after radiation therapy. Chemotherapy is given through a needle in a vein (intravenously). You may be offered one of the following chemotherapy combinations:

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

The combination of chemotherapy drugs used and number of cycles given depends on the tumour’s prognosis group. Tumours are grouped according to the International Germ Cell Cancer Consensus Group classification system. Tumours in the good prognosis group may be treated with BEP or EP. Tumours in the intermediate prognosis group may be treated with BEP or VIP. When bleomycin affects the lungs or there is a high risk that it will cause lung damage, EP or VIP may be used instead of BEP.

Find out more about surgery, active surveillance, radiation therapy and chemotherapy for testicular cancer.

Surgery is the first treatment for stage 3 seminoma. An orchiectomy is done. In some cases, a retroperitoneal lymph node dissection (RPLND) to remove the lymph nodes from the back of the abdomen (the retroperitoneum) is also done after chemotherapy. In rare cases, surgery is done to remove tumours in the brain.

Chemotherapy is a standard treatment for stage 3 seminoma. It is usually given after an orchiectomy. Chemotherapy may also be used before surgery if the cancer has already spread and doctors have confirmed the spread is seminoma by doing a biopsy. Chemotherapy is given through a needle in a vein. You may be offered one of the following chemotherapy combinations:

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

The combination of chemotherapy drugs used depends on the tumour’s prognosis. Tumours are grouped according to the International Germ Cell Cancer Consensus Group classification system. Tumours in the good prognosis group may be treated with BEP or EP. Tumours in the intermediate prognosis group may be treated with BEP or VIP. When bleomycin affects the lungs or there is a high risk that it will cause lung damage, EP or VIP may be used instead of BEP.

Active surveillance is offered after chemotherapy to look for any cancer that remains (called residual disease) and signs that the cancer has come back. If scans and tumour marker levels are normal, you may not need further treatment. It’s common for imaging tests to show a mass after treatment, usually in the lungs or the retroperitoneal lymph nodes. The mass is often non-cancerous (benign), and treatment is active surveillance to see if it grows over time. If it is larger than 3 cm or grows to be larger than 3 cm, your healthcare team may recommend surgery to remove it. Larger masses are more likely to be cancerous.

Radiation therapy may be offered for stage 3 seminoma if the cancer has spread to the brain.

Find out more about surgery, chemotherapy, active surveillance and radiation therapy for testicular cancer.

Recurrent seminoma cancer means that the cancer has come back after it has been treated. If seminoma cancer comes back after treatment, it usually happens within the first 2 to 3 years after diagnosis or initial chemotherapy. You may be offered the following treatments for recurrent seminoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy is the main treatment for recurrent seminoma. The combination of chemotherapy drugs given will depend on the treatments that were used to treat the original cancer.

If you were given radiation therapy after surgery to treat the original cancer, you may be offered BEP, EP or VIP for recurrent seminoma.

If you were given BEP or EP to treat the original cancer, you may be offered a different chemotherapy drug combination. This is called salvage chemotherapy. You may be offered one of the following combinations, given through a needle into a vein:

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

You may be offered high-dose chemotherapy with carboplatin and etoposide if testicular cancer comes back after being treated with standard-dose chemotherapy or salvage 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).

Chemotherapy can also be used as palliative therapy if the cancer comes back after most other treatments. Palliative therapy is given to relieve symptoms rather than to treat the cancer itself. Palliative chemotherapy that may be used for seminoma includes:

• etoposide given by mouth (orally)
• gemcitabine with oxaliplatin or paclitaxel given through a needle in a vein

Surgery may be done to remove a seminoma if it comes back after salvage chemotherapy or high-dose chemotherapy with a stem cell transplant.

Radiation therapy can be used if the cancer comes back during active surveillance or after chemotherapy with carboplatin. The cancer must be only in the lymph nodes at the back of the abdomen. Radiation is directed at those lymph nodes.

Find out more about chemotherapy, surgery and radiation therapy for testicular cancer.

Talk to your doctor about clinical trials open to people with testicular cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments donʼt work anymore, theyʼre not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you canʼt have or donʼt want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.