Surgery for testicular cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Most people with testicular cancer 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 being able to get someone pregnant (your fertility) is important to you after treatment.

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 you've had one or both testicles removed and chemotherapy

The following types of surgery are commonly used to treat testicular cancer.

Surgery to remove one or both testicles is the first treatment for any stage of testicular cancer. It’s usually done as part of the diagnosis. The surgery is called a radical inguinal orchiectomy, or it’s sometimes just called an orchiectomy. If both testicles are removed, it’s called a bilateral orchiectomy.

In a radical inguinal orchiectomy, the surgeon removes the testicle and spermatic cord from the scrotum through a small cut in the groin. It’s possible to remove a testicle by making a cut in the scrotum (called a transscrotal orchiectomy). The transscrotal method is never used when cancer is suspected because it may allow cancer cells to spread into the lymph vessels. Both testicles may be removed if doctors believe there is cancer in both of them.

When having the surgery, you will either be under general anesthesia (you will be unconscious) or you will have an epidural anesthetic that causes a loss of feeling or awareness in the abdomen and lower body. An epidural anesthetic is sometimes called spinal anesthesia. The surgery takes about 30 minutes and you can usually go home the same day.

A testicular prosthesis, which can also be called an artificial testicle, can be placed in the scrotum after an orchiectomy. The prosthesis has the same weight, shape and feel as a normal testicle. It doesn’t function like a normal testicle – it just helps improve the appearance of the scrotum after your testicle is removed.

The prosthesis can be placed at the same time as surgery to remove the testicle or it can be done later in a separate surgery. Some people 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.

Surgery to remove lymph nodes from the back of the abdomen is called a retroperitoneal lymph node dissection (RPLND). It may be done for:

• stage 1 and stage 2 non-seminomas
• non-seminoma cancer that remains after chemotherapy (called residual disease) that is larger than 1 cm
• any type of testicular cancer that doesn’t respond to chemotherapy

This surgery is done under general anesthesia and takes several hours to complete. After making a large cut in the middle of the abdomen, the surgeon removes lymph nodes from the back of the abdomen (the retroperitoneum). An ipsilateral RPLND means that the lymph nodes on the same side of the body as the tumour are removed. If lymph nodes from both sides of the body are removed, it is called a bilateral RPLND.

An RPLND can be done at the same time as an orchiectomy or it can be done later.

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

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

Surgery for testicular cancer may cause these side effects:

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

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.