Surgery for testicular cancer

Most men with testicular cancer will have surgery. The type of surgery you have depends mainly on stage of the cancer and how it responds to treatment. When planning surgery, your healthcare team will also consider other factors, such as your tumour marker levels and if you wish to have children (get someone pregnant).

Surgery may be done for different reasons. You may have surgery to:

• diagnose and help stage testicular cancer
• completely remove the tumour
• remove tumours that have spread to other parts of the body, such as the lungs
• remove any cancer that remains after a radical inguinal orchiectomy (an orchiectomy) and chemotherapy (called residual disease)

The following types of surgery are most commonly used to treat testicular cancer. You may also have other treatments before or after surgery.

A radical inguinal orchiectomy (also called orchiectomy) is the first treatment for any stage of testicular cancer and it is usually done as part of the diagnosis. In rare cases, chemotherapy may be given before this surgery is done.

While you are under general anesthesia (you will be unconscious) or spinal (epidural) anesthesia, the surgeon makes a small cut in the groin. The surgeon removes the testicle and spermatic cord from the scrotum through the opening in the groin. The testicle isn’t removed through the scrotum (called a transscrotal orchiectomy) because there is a risk that doing so could spread cancer cells into the lymph vessels. Both testicles may be removed (called a bilateral orchiectomy) if doctors believe both testicles have cancer in them. The surgery takes about 30 minutes and you can usually go home the same day.

A testicular prosthesis (artificial testicle) can be placed in the scrotum after an orchiectomy. The prosthesis may be placed at the same time as surgery to remove the testicle or it can be placed during another surgery done later. This surgery helps improve the appearance of the scrotum after your testicle is removed. A testicular prosthesis has the same weight, shape and feel as a normal testicle. It is used for cosmetic reasons only and does not function like a normal testicle. Some men might want a prosthesis, while others might not. Talk to your healthcare team about getting a testicular prosthesis and the best time to place the prosthesis.

A retroperitoneal lymph node dissection (RPLND) may be done for stages 1 and 2 non-seminomas or for any type of testicular cancer that doesn’t respond to chemotherapy.

While you are under general anesthesia, the surgeon makes a large cut in the middle of the abdomen. The surgeon removes lymph nodes from the back of the abdomen (called the retroperitoneum). If the surgeon removes lymph nodes from the same side of the body as the tumour, it is called an ipsilateral RPLND. If the surgeon removes lymph nodes from both sides of the body, it is called a bilateral RPLND. The surgery takes several hours to complete.

An RPLND may be done at the same time as an orchiectomy, or it can be done later during another surgery.

Sometimes testicular cancer doesn’t completely respond to chemotherapy that is given after an orchiectomy. The cancer that remains after these primary treatments is called residual disease. Surgery used to remove residual disease is called postchemotherapy surgery. Postchemotherapy surgery for residual lesions is considered standard for non-seminoma residual lesions.

If there are higher levels of tumour markers in the blood suggesting residual active cancer, surgery for residual lesions is called salvage surgery.

Salvage surgery may include a bilateral RPLND if it wasn’t done during a previous surgery.

Surgery may also be used to remove testicular cancer that has spread (metastasized) to the lungs, mediastinum, brain, liver or neck.

Side effects can happen with any type of treatment for testicular cancer, but everyone’s experience is different. Some men have many side effects. Others have only a few side effects. Your surgeon will discuss side effects in great detail with you before the surgery.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for testicular cancer may cause these side effects:

• pain
• nausea and vomiting
• bleeding
• infection
• changes to body image
• sexual problems for men, including erectile dysfunction and retrograde ejaculation
• fertility problems

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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