Chemotherapy for testicular cancer
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells or slow their growth, while causing the least possible damage to healthy cells.
When chemotherapy is given after surgery, is known as adjuvant treatment. If the cancer is only in the testicle, it can usually be treated with surgery alone and chemotherapy may not be needed. Sometimes, however, your treatment team assesses that there is a moderate risk of the cancer spreading or returning. In this case, a single dose (or two cycles) of chemotherapy will be recommended. After treatment, you will be monitored through surveillance with follow-up appointments and tests for 5-10 years.
In rare cases, when the cancer has spread to other parts of the body, chemotherapy may be given before surgery as the primary treatment.
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There are many types of chemotherapy drugs. Some people are given a drug called carboplatin, which is often used for early stage seminoma cancer after surgery. Other drugs commonly used for testicular cancer are bleomycin, etoposide and cisplatin. When these three drugs are used together, it is called BEP chemotherapy.
Chemotherapy is usually put into a vein (intravenously) through a drip. Bleomycin may also be given by injection into a muscle (intramuscularly). In either case, chemotherapy is given in cycles, which means you will receive the drugs for a period of time and then have a rest period of a few weeks before starting a new cycle.
The number of treatment cycles you have will depend on the type and stage of the cancer. Your doctor will give you more information. You will probably have to visit the hospital as an outpatient each time you have chemotherapy.
For more on this, see Chemotherapy.
Chemotherapy drugs damage cells as they divide. This makes the drugs effective against cancer cells, which divide more rapidly than most normal cells do. However, some normal cells – such as hair follicles, blood cells, and cells inside the mouth or bowel – also divide rapidly. Side effects can occur when chemotherapy damages these normal cells.
Everyone reacts differently to chemotherapy. Some people don’t experience any side effects, while others have a few. Side effects are usually temporary, and there are medicines that can help reduce your discomfort. Talk to your doctor or nurse about any side effects you have and ways to manage them.
Most people feel tired during chemotherapy, particularly as treatment progresses.
For more on this, see Fatigue.
Low white blood cell count
About a week after a treatment session, your white blood cell levels may drop, making you more prone to infections. If you feel unwell or have a fever higher than 38°C, call your doctor immediately or go to the nearest hospital emergency department.
Nausea and vomiting
It is common to feel ill or vomit within a few hours of chemotherapy treatment. Anti-nausea medicines can prevent or at least reduce this feeling. In most cases, an anti-nausea medicine will be injected at the same time as the chemotherapy is given. You may be given other anti-nausea medicines to take home in case nausea occurs. These are available in many forms, including tablets that you swallow, wafers that dissolve on the tongue and suppositories to put into your bottom (rectum). Tell your medical team if you still feel sick as you may be able to try a different form of medicine.
For more on this, listen to our podcast on Appetite Loss and Nausea.
Sometimes chemotherapy can affect the nerve endings in the bowel, making it hard to pass a bowel motion and causing constipation. More often, constipation occurs as a side effect of the anti-nausea medicines. Your medical team can prescribe medicines to help with constipation.
Chemotherapy often causes hair loss from the head and body, but hair usually grows back once treatment is over.
For more on this, see Hair loss.
Chemotherapy can affect erections, but this is usually temporary. You may also find you have a lower sex drive (libido).
For more on this, see Effects on sexuality and intimacy.
Lower sperm production
The chemotherapy drugs may reduce the number of sperm you produce and their ability to move (motility). This can cause temporary or permanent infertility. Speak with your doctor about sperm banking before starting chemotherapy.
For more on this, see Fertility and cancer.
You will still need to use contraception to protect your partner from any drugs in your semen and to avoid pregnancy.
Using contraception during treatment
Even if treatment lowers sperm production, there is still a chance your partner could become pregnant. Because chemotherapy and radiation therapy can damage sperm, you will need to use contraception during treatment and sometimes for some months afterwards to prevent pregnancy. Your doctor will discuss this with you. For more on this, see Effects on fertility.
Some drugs affect the nerves, causing numb or tingling fingers or toes. This is called peripheral neuropathy. It typically improves after treatment is finished.
For more on this, see Peripheral neuropathy.
Ringing in the ears
Some types of chemotherapy drugs can cause short-term ringing or buzzing in the ears. This is known as tinnitus.
Breathlessness, cough or unexplained symptoms
Some drugs can damage the lungs or kidneys. You may have lung and kidney function tests to check the effects of the drugs on your organs.
Risk of heart disease
Having chemotherapy for testicular cancer increases the risk of developing heart (cardiovascular) disease. You will have tests to check your heart function before and after treatment.
Risk of other cancers
People who have chemotherapy for testicular cancer are at a slightly higher risk of developing leukaemia, which is a blood cancer. This outcome is extremely rare, so the benefit of receiving treatment outweighs this risk. However, you will have regular check-ups after treatment to test for cancer.
Video: What is chemotherapy?
Learn more about chemotherapy in this short video.
Podcast: Brain Fog and Cancer
Download a PDF booklet on this topic.
Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; A/Prof Nicholas Brook, Senior Consultant Urological Surgeon, Royal Adelaide Hospital and The University of Adelaide, SA; Clinical A/Prof Peter Grimison, Medical Oncologist, Chris O’Brien Lifehouse and The University of Sydney, NSW; Dr Tanya Holt, Senior Radiation Oncologist, Radiation Oncology Princess Alexandra Hospital Raymond Terrace (ROPART), QLD; Brodie Kitson, Consumer; Elizabeth Medhurst, Genitourinary and Stereotactic Ablative Body Radiotherapy (SABR) Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria.
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