TESTES CANCER

The University of Chicago Urologic Oncology Program
The University of Chicago is a leader in the treatment of testes cancer. Urologists at the University of Chicago specialize in the latest open and laparoscopic surgical techniques to treat testes tumors, including orchiectomy (removal of the testes) and open and laparoscopic retroperitoneal lymph node dissection [RPLND].

• For more details on orchiectomy, please click here.
• To learn more about RPLND – open and laparoscopic – click here.

In combination with colleagues in Medical Oncology and the Cancer Research Center, we offer a comprehensive and diverse option of therapies for men with testes cancer.

An Overview of Testes Cancer
Testes cancer is a common cancer among young American men. This year, there are estimated to be nearly -- new cases. Many men have a history of trauma or undescended testes. Fortunately, most patients with testis cancer will be cured of their disease.

Treatment for testes cancer depends upon several factors, including the type of testes cancer and the extent of disease. Treatments can consist of surgery, radiotherapy, chemotherapy, or a combination of these approaches. Any of the surgeons at the University of Chicago specializing in the treatment of testes cancer will gladly spend the time necessary to answer all of your questions and concerns.

Diagnosis is made by removing the testes and examining its content under a microscope. Most men present to their doctors with a testicular mass (a hard tumor in there scrotum) felt by them or a significant other. Some men will have sensations of “heaviness” in their testes. A select group of men will have a tumor present elsewhere in their bodies (i.e. a neck mass or abdominal/retroperitoneal mass) that is removed and then determined to be testicular cancer.

In addition to feeling the testes, your doctor may obtain an ultrasound X-ray study of your testes. He should obtain a chest X-ray and CT scan of the abdomen and pelvis to rule-out any metastatic spread. Several blood tests, including an alpha-feto-protein, a beta-hCG, and an LDH will be obtained. Your doctor will discuss with you the role of sperm-banking, to preserve the ability to father children after treatment for the testes cancer is completed.

Surgery is required to remove the diseased testes. This operation is called a radical orchiectomy. During this operation, the testes and its surrounding capsule and “cord” are removed. The scrotum is left untouched and, as such, should appear the same after surgery. The incision is made in the lower abdomen, akin to hernia surgery. The testes is removed through the lower abdomen to prevent untoward spread of tumor cells.

Once the involved testes is removed, several management options become available. Some of this depends upon the type of testes cancer found in the testes, either a seminoma or a non-seminoma. Several other types of rare tumors can be found in the testes. The treatment of these cancers is not described here.

Seminoma
Often, patients without any evidence of cancer outside of the testes will undergo (prophylactic) radiotherapy. Some may undergo (prophylactic) chemotherapy.

Should there be any residual cancer (evidenced by a residual mass on CT scan), chemotherapy will be used.

Non-seminoma
Patients without any evidence of cancer outside of the testes (negative blood tests and CT scans) are given the choice of observation (close surveillance with CT scans and blood tests), surgery (RPLND), and chemotherapy. RPLND and chemotherapy are often recommended as at least 30% of men with clear CT scans and blood tests are harboring cancer cells in their retroperitoneal lymph nodes.

• RPLND involves removing all of the lymph tissue in the retroperitoneum (the area of the body behind the intestines). This can be accomplished through both minimally invasive (laparoscopic) or open approach.
• To learn more about RPLND, click here.

Both chemotherapy and surgery are equally effective for these patients.

Should there be any residual cancer (evidenced by elevated blood tests – predominantly alpha-feto-protein and beta-hCG), chemotherapy will be used. Should there be any residual cancer (evidenced by a small mass on CT scans), surgery may be used, especially if the blood tests are negative. Alternatively, chemotherapy can be used and will be should the blood tests be elevated. Should there be any residual cancer (evidenced by a large mass on CT scans), chemotherapy whether or not the blood tests are positive.

In some patients, there will be a residual mass after chemotherapy. In these cases, if the blood tests have become normal, surgery is often recommended to remove the remaining tissue and ascertain that it is not cancerous. This is called a post-chemo-RPLND and is more difficult than a standard RPLND. Bleeding, infection, infertility, lymphocele, and injury to surrounding organs and structures are more likely in the post-chemo-RPLND.

Make sure to discuss with your doctor the role, if any, for sperm banking prior to either chemotherapy or RPLND.

Surgical Treatment Options for Testes Cancer
Radical Orchiectomy (click here for FAQs about Radical Orchiectomy)

• This involves removal of the testes, the surrounding capsule, and the spermatic cord – the structure that connects the testes to the abdomen.
• These are performed through an incision in the lower part of the abdomen: the scrotum is left untouched. This is to prevent spread of testes cancer cells. A prosthetic testes can be placed at the time of surgery.
• After surgery, the patient is advised to be sedentary for several days and is given and ice pack and athletic supporter to help prevent untoward bleeding..
• If appropriate, sperm banking before orchiectomy should be considered.

RPLND [Retroperitoneal Lymph Node Dissection] (click here for FAQs about RPLND)

• This involves removal of the lymph tissue from the retroperitoneum, the part of the abdomen behind the intestines. All, or part of the lymph tissue (either a standard or a modified template RPLND) may be removed. This operation involves surgery close to the kidneys, the ureters, the intestines, large blood vessels, and nerves that assist with reproduction.
• The RPLND can be performed laparoscopically (through a small incision) or open (through a large incision). The large incision may be in the middle of the abdomen or maybe up near the lungs. The actual location and approach will be a topic of discussion for you and your physician.
• RPLNDs performed after chemotherapy are much more complicated and the rate of side effects (such as lymphocele, injury to surrounding structures, bleeding) are higher. Post-chemo-RPLNDs are not performed laparoscopically.
• Doctors at the University of Chicago perform nerve-sparing RPLNDs, so that normal reproduction can occur after treatment is complete.

Surgeons at the University of Chicago are trained in the most up-to-date and technologically-advanced methods of treating prostate cancers. At you appointment, your surgeon will be glad to discuss all of these treatment options with you, as well as any applicable clinical trial or experimental therapies.