Surgery to remove a cancerous testicle is called orchiectomy. In most cases, orchiectomy is performed during testicular cancer diagnosis. The testicle is removed through an incision in the groin, and tissue samples are examined to determine the stage of the cancer.
For some patients, especially those with nonseminoma testicular cancers, surgery may also involve removal of lymph nodes in the abdominal area. Retroperitoneal lymph node dissection, or RPLND, is either done at the same time as the orchiectomy, or in a second surgical procedure. Standard RPLND requires a large abdominal incision and several days of recovery time in a hospital. This procedure can also be done with laparoscopy, a minimally invasive surgery technique that uses much smaller incisions.
Because both surgical procedures may affect fertility, and because most testicular cancers occur in young men, it's important for patients to discuss sperm-banking with their doctor. If the patient wants to start a family at some point, their sperm cells are collected before cancer treatment and frozen for future use.
For men who may be uncomfortable with their appearance after orchiectomy, they can have a prosthesis implanted in their scrotum that provides the look and feel of a real testicle.
Seminomas, which are the most common form of testicular tumor, are very sensitive to radiation treatment. In fact, the treatment dosage is only about one-third of that required for prostate cancer, and the treatment cycle is only two weeks.
Radiation is performed after surgery to remove the testicle (orchiectomy). If the tumor was a seminoma, the oncologist may choose "watchful waiting" to see if the cancer returns, or use radiation to treat the lymph nodes along the spine, where 20% of recurrences are located. Even if the cancer comes back, it is still very treatable with either radiation or chemotherapy in the majority of cases. Radiation treatment has an average recurrence rate of about 5%. Radiation can also be used after chemotherapy if any cancer remains.
Other types of testicular cancers are more resistant to radiation, and are more commonly treated with orchiectomy and removal of affected lymph nodes.
Chemotherapy is most often used in conjunction with surgery to remove the testicle. For men with advanced tumors that have spread beyond the testicle or metastasized to distant areas of the body, chemotherapy is administered after surgery to make sure all of the cancer cells have been destroyed.