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Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?

Get the facts

Your options

For most men faced with testicular cancer, surgery to remove the testicle is the first treatment. After that surgery, you and your doctor must decide what to do next. For stage I seminoma testicular cancer, these are your choices:

This decision aid is about stage I seminoma testicular cancer. The treatment decision for stage I nonseminoma testicular cancer is different.

Key points to remember

  • Testicular cancer is highly curable. No matter what treatment is chosen, more than 95 out of 100 of men with seminoma cancer will have their cancer cured.1
  • Many experts recommend surveillance as the preferred option for stage I seminoma cancer. About 80 to 85 out of 100 men with seminoma cancer who choose surveillance don't need any additional treatment.1 If your cancer comes back and is found early, you will have the same chances for survival as men who had treatment right after their surgery.
  • Some men prefer to have more treatment to lower their chances for the cancer coming back (recurring). But radiation and chemotherapy have some serious risks and side effects.
  • Surveillance lets you avoid the risks and side effects from radiation therapy or chemotherapy. Or it at least lets you put them off for a while.
  • For surveillance, you must be willing to have frequent checkups and tests. Without this close follow-up, if the cancer comes back, it might not be found until it has spread and is harder to treat.
  • Treatments might harm your fertility, so ask your doctor about banking your sperm before treatment.
FAQs

What is stage I seminoma testicular cancer?

There are two main types of testicular cancer: seminoma and nonseminoma. Seminomas grow and spread slowly. They are less likely to spread to the lungs, liver, and brain than nonseminomas.

"Stage I" means that the cancer is only in the testicle and hasn't spread beyond it.

Both types of cancer are very often cured, especially if they are found and treated early. Compared to other forms of cancer, testicular cancer—even when it has spread to other parts of the body—has a very high cure rate.

What are the treatment choices for stage I seminoma testicular cancer?

The first treatment is surgery to remove the testicle. After that, most men have three choices: surveillance, radiation, and chemotherapy (often called chemo). About 15 to 20 out of 100 men who choose surveillance will need more treatment. But any of the three choices will cure seminoma cancer in more than 95 out of 100 men.1

Surveillance

Surveillance means that you are being watched closely by your doctor but are not having further treatment.

You have exams, chest X-rays, and blood tests regularly during the first few years, as well as CT scans. It can be hard to go to the doctor's office that often. Unless your cancer comes back, the number of checkups and tests will gradually decrease over the next 10 years.

With surveillance, you may be able to avoid the risks and side effects of radiation or chemo. About 80 to 85 out of 100 men who choose surveillance find that surgery cured the seminoma cancer and they don't need more treatment.1

Even when cancer is found after a period of surveillance, it is usually possible to cure the cancer if it's found early. Because of this, many experts recommend surveillance as the preferred option for stage I seminoma cancer.

Radiation treatment

Radiation most often is focused on the lymph nodes in the pelvis and lower back, because that is where the cancer usually spreads.

When this cancer is found very early, it can be very hard to tell if these lymph nodes are cancerous. That's why radiation may be used even when no cancer can be seen.

Chemotherapy

Chemotherapy (or chemo) is the use of very strong drugs to kill cancer cells. For men with stage I seminoma, chemotherapy may be used instead of radiation therapy. It is less toxic than radiation therapy and may work just as well to keep cancer from coming back.1

Your doctor can talk to you about which chemo drugs have the least harmful side effects.

What are the risks of surveillance?

Perhaps the greatest risk of choosing surveillance is missing your follow-up tests and exams. Without regular testing and checkups, you can miss cancer that has returned until it spreads beyond the lymph nodes and is harder to cure. If you choose surveillance, it's very important to strictly follow your doctor's schedule of tests and exams.

Other risks include radiation exposure from CT scans, which need to be done for surveillance. Also, if your cancer does come back, you will need to have a higher dose of radiation or chemotherapy than if you'd had either of these treatments soon after your surgery.

When cancer does come back during surveillance, it usually hasn't spread beyond the lymph nodes in the lower back and pelvis. It can usually be treated successfully when the testing schedule has been followed closely.

What are the risks of radiation treatment?

Radiation treatment has side effects. Most (such as fatigue, nausea, vomiting, and diarrhea) are short-term. That means they go away when treatment is done. Other side effects can affect your future lifestyle and health. Long-term risks from radiation include infertility, an increased risk of other cancers, and having problems with your heart.

These serious side effects have made the use of radiation treatment for stage I seminoma cancer much less common. It is no longer considered routine treatment.

What are the risks of chemotherapy?

Chemotherapy (or chemo) for testicular cancer has caused infertility in some men. Most men diagnosed with this cancer are younger than 35. So it's something to think about when you choose which treatment to use.

Men who are going to have this treatment should bank their sperm ahead of time if they want to father children. Talk to your doctor about any fertility concerns you may have.

Chemo has side effects. Most (such as nausea, vomiting, hair loss, mouth sores, and diarrhea) are short-term. Some are more serious, such as possible infertility. But the full range of long-term problems that might be caused by medicines such as carboplatin aren't yet known.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Try surveillanceTry surveillance
  • You have frequent checkups, X-rays, blood tests, and CT scans during the first few years.
  • More than 95 out of 100 men who have surveillance are cured. (About 15 to 20 out of 100 men will need more treatment before they are cured.)1
  • It can be hard to follow the long and intense schedule of checkups and tests for surveillance.
  • The cancer is more likely to come back with surveillance. About 15 to 20 out of 100 men who choose it will need more treatment (radiation and/or chemo).1
Have radiationHave radiation
  • You have radiation treatments every weekday for a few weeks.
  • Treatments take 10 to 15 minutes and are painless.
  • Radiation will cure the cancer in more than 95 out of 100 men.1
  • Short-term side effects may include fatigue, nausea, vomiting, and diarrhea.
  • Radiation can cause serious long-term health problems. These include getting other cancers in the future. But this problem isn't common.
  • Radiation can cause infertility, but this isn't common.
Have chemotherapyHave chemotherapy
  • The chemo drug is usually injected into a vein in your hand or arm. This method is called an IV.
  • You may get chemo in the hospital or in a clinic.
  • You may have treatments over the course of 3 months.
  • Chemo will cure the cancer in more than 95 out of 100 men.1
  • Side effects of chemo can include nausea and vomiting, hair loss, mouth sores, and diarrhea.
  • Chemo can cause infertility. But this isn't common.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about choosing radiation therapy, chemotherapy, or surveillance for stage I seminoma

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When I was a senior in high school, my doctor found a lump on my testicle during a physical. After doing some tests, he told me I had testicular cancer. I guess the good news was that we had found it early enough that it might not have spread yet. After surgery, my doctor looked at my test results and said that there was a good chance that orchiectomy by itself might cure me. I decided that I didn't want to go through with radiation or chemotherapy unless I absolutely had to, no matter how many checkups I had to go to. It's been about 3 years now, and so far the cancer has not come back. I still go in pretty often for exams and blood tests, but to me it's worth it. I think I made the right choice.

Stephen, age 20

About 6 months after our wedding, I discovered a lump on my testicles when I was in the shower. Needless to say, I was very concerned, and I scheduled an appointment with my doctor the next day. Within 3 weeks, I was having an orchiectomy. After that, my doctor said that my cancer was at an early stage and that I was very lucky to have found it because the lump wasn't very big. He told me that I could either have radiation therapy, chemotherapy, or wait and see if I was cured. I decided to wait and see. That was 2 years ago. Last week, my doctor found something on my CT scan that didn't look right. As it turns out, my cancer has come back. So now I'm going to have to have radiation therapy anyway. I wish I had just gotten it over with 2 years ago rather than going through all the checkups and tests, and worrying about it all this time.

Randall, age 29

Around 4 years ago, I found a lump on my testicles. After being diagnosed with early-stage seminoma testicular cancer, I decided to do chemo right away rather than surveillance or radiation therapy. My doctor told me that the type of chemo I got doesn't carry the same risk of getting another kind of cancer later in life. I know that there is still a small chance of being infertile from the chemotherapy. But to me it's an acceptable risk. My testicular cancer has been cured, and I feel great.

Adolfo, age 32

When I was 29, I was diagnosed with stage I seminoma testicular cancer. At the time, I was told that my cancer was found at a very early stage and that I could either choose radiation or surveillance after orchiectomy. I decided to go with radiation therapy, because I wanted my cancer to be cured as soon as possible. At the age of 46, I was diagnosed with leukemia, which my doctor says could be a result of the radiation therapy I received during treatment for testicular cancer. There's no way to be sure that it's what caused my leukemia. But now I wish I had thought about a surveillance program a little more seriously.

Jeff, age 49

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I want surveillance, since I might not need more treatment.

Not important
Somewhat important
Very important

I want radiation or chemo for the best chance of cure at the start.

Not important
Somewhat important
Very important

I'd rather have side effects from treatment than have surveillance.

Not important
Somewhat important
Very important

I can make sure I go to checkups and tests during surveillance.

Not important
Somewhat important
Very important

I don't mind banking my sperm to have treatment.

Not important
Somewhat important
Very important

My other important reasons:

Not important
Somewhat important
Very important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surveillance

NOT using surveillance

Leaning toward
Undecided
Leaning toward

Radiation treatment

NOT having radiation treatment

Leaning toward
Undecided
Leaning toward

Chemotherapy

NOT having chemotherapy

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Which treatment means having the most checkups and tests during the first few years?

  • SurveillanceYou're right. Surveillance requires an intense schedule of frequent checkups and tests.
  • RadiationSorry, that's wrong. It's surveillance that requires an intense schedule of frequent checkups and tests.
  • ChemotherapySorry, that's wrong. It's surveillance that requires an intense schedule of frequent checkups and tests.
  • I'm not sureIt may help to go back and read "Get the Facts." Surveillance requires an intense schedule of frequent checkups and tests.
2.

If you're worried that treatment will leave you infertile, can you bank your sperm ahead of time?

  • YesThat's right. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
  • NoSorry, that's wrong. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
  • I'm not sureIt may help to go back and read "Get the Facts." If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology

References
Citations
  1. National Cancer Institute (2012). Testicular Cancer Treatment PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

For most men faced with testicular cancer, surgery to remove the testicle is the first treatment. After that surgery, you and your doctor must decide what to do next. For stage I seminoma testicular cancer, these are your choices:

This decision aid is about stage I seminoma testicular cancer. The treatment decision for stage I nonseminoma testicular cancer is different.

Key points to remember

  • Testicular cancer is highly curable. No matter what treatment is chosen, more than 95 out of 100 of men with seminoma cancer will have their cancer cured.1
  • Many experts recommend surveillance as the preferred option for stage I seminoma cancer. About 80 to 85 out of 100 men with seminoma cancer who choose surveillance don't need any additional treatment.1 If your cancer comes back and is found early, you will have the same chances for survival as men who had treatment right after their surgery.
  • Some men prefer to have more treatment to lower their chances for the cancer coming back (recurring). But radiation and chemotherapy have some serious risks and side effects.
  • Surveillance lets you avoid the risks and side effects from radiation therapy or chemotherapy. Or it at least lets you put them off for a while.
  • For surveillance, you must be willing to have frequent checkups and tests. Without this close follow-up, if the cancer comes back, it might not be found until it has spread and is harder to treat.
  • Treatments might harm your fertility, so ask your doctor about banking your sperm before treatment.
FAQs

What is stage I seminoma testicular cancer?

There are two main types of testicular cancer: seminoma and nonseminoma. Seminomas grow and spread slowly. They are less likely to spread to the lungs, liver, and brain than nonseminomas.

"Stage I" means that the cancer is only in the testicle and hasn't spread beyond it.

Both types of cancer are very often cured, especially if they are found and treated early. Compared to other forms of cancer, testicular cancer—even when it has spread to other parts of the body—has a very high cure rate.

What are the treatment choices for stage I seminoma testicular cancer?

The first treatment is surgery to remove the testicle. After that, most men have three choices: surveillance, radiation, and chemotherapy (often called chemo). About 15 to 20 out of 100 men who choose surveillance will need more treatment. But any of the three choices will cure seminoma cancer in more than 95 out of 100 men.1

Surveillance

Surveillance means that you are being watched closely by your doctor but are not having further treatment.

You have exams, chest X-rays, and blood tests regularly during the first few years, as well as CT scans. It can be hard to go to the doctor's office that often. Unless your cancer comes back, the number of checkups and tests will gradually decrease over the next 10 years.

With surveillance, you may be able to avoid the risks and side effects of radiation or chemo. About 80 to 85 out of 100 men who choose surveillance find that surgery cured the seminoma cancer and they don't need more treatment.1

Even when cancer is found after a period of surveillance, it is usually possible to cure the cancer if it's found early. Because of this, many experts recommend surveillance as the preferred option for stage I seminoma cancer.

Radiation treatment

Radiation most often is focused on the lymph nodes in the pelvis and lower back, because that is where the cancer usually spreads.

When this cancer is found very early, it can be very hard to tell if these lymph nodes are cancerous. That's why radiation may be used even when no cancer can be seen.

Chemotherapy

Chemotherapy (or chemo) is the use of very strong drugs to kill cancer cells. For men with stage I seminoma, chemotherapy may be used instead of radiation therapy. It is less toxic than radiation therapy and may work just as well to keep cancer from coming back.1

Your doctor can talk to you about which chemo drugs have the least harmful side effects.

What are the risks of surveillance?

Perhaps the greatest risk of choosing surveillance is missing your follow-up tests and exams. Without regular testing and checkups, you can miss cancer that has returned until it spreads beyond the lymph nodes and is harder to cure. If you choose surveillance, it's very important to strictly follow your doctor's schedule of tests and exams.

Other risks include radiation exposure from CT scans, which need to be done for surveillance. Also, if your cancer does come back, you will need to have a higher dose of radiation or chemotherapy than if you'd had either of these treatments soon after your surgery.

When cancer does come back during surveillance, it usually hasn't spread beyond the lymph nodes in the lower back and pelvis. It can usually be treated successfully when the testing schedule has been followed closely.

What are the risks of radiation treatment?

Radiation treatment has side effects. Most (such as fatigue, nausea, vomiting, and diarrhea) are short-term. That means they go away when treatment is done. Other side effects can affect your future lifestyle and health. Long-term risks from radiation include infertility, an increased risk of other cancers, and having problems with your heart.

These serious side effects have made the use of radiation treatment for stage I seminoma cancer much less common. It is no longer considered routine treatment.

What are the risks of chemotherapy?

Chemotherapy (or chemo) for testicular cancer has caused infertility in some men. Most men diagnosed with this cancer are younger than 35. So it's something to think about when you choose which treatment to use.

Men who are going to have this treatment should bank their sperm ahead of time if they want to father children. Talk to your doctor about any fertility concerns you may have.

Chemo has side effects. Most (such as nausea, vomiting, hair loss, mouth sores, and diarrhea) are short-term. Some are more serious, such as possible infertility. But the full range of long-term problems that might be caused by medicines such as carboplatin aren't yet known.

2. Compare your options

  Try surveillance Have radiation
What is usually involved?
  • You have frequent checkups, X-rays, blood tests, and CT scans during the first few years.
  • You have radiation treatments every weekday for a few weeks.
  • Treatments take 10 to 15 minutes and are painless.
What are the benefits?
  • More than 95 out of 100 men who have surveillance are cured. (About 15 to 20 out of 100 men will need more treatment before they are cured.)1
  • Radiation will cure the cancer in more than 95 out of 100 men.1
What are the risks and side effects?
  • It can be hard to follow the long and intense schedule of checkups and tests for surveillance.
  • The cancer is more likely to come back with surveillance. About 15 to 20 out of 100 men who choose it will need more treatment (radiation and/or chemo).1
  • Short-term side effects may include fatigue, nausea, vomiting, and diarrhea.
  • Radiation can cause serious long-term health problems. These include getting other cancers in the future. But this problem isn't common.
  • Radiation can cause infertility, but this isn't common.
  Have chemotherapy
What is usually involved?
  • The chemo drug is usually injected into a vein in your hand or arm. This method is called an IV.
  • You may get chemo in the hospital or in a clinic.
  • You may have treatments over the course of 3 months.
What are the benefits?
  • Chemo will cure the cancer in more than 95 out of 100 men.1
What are the risks and side effects?
  • Side effects of chemo can include nausea and vomiting, hair loss, mouth sores, and diarrhea.
  • Chemo can cause infertility. But this isn't common.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about choosing radiation therapy, chemotherapy, or surveillance for stage I seminoma

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When I was a senior in high school, my doctor found a lump on my testicle during a physical. After doing some tests, he told me I had testicular cancer. I guess the good news was that we had found it early enough that it might not have spread yet. After surgery, my doctor looked at my test results and said that there was a good chance that orchiectomy by itself might cure me. I decided that I didn't want to go through with radiation or chemotherapy unless I absolutely had to, no matter how many checkups I had to go to. It's been about 3 years now, and so far the cancer has not come back. I still go in pretty often for exams and blood tests, but to me it's worth it. I think I made the right choice."

— Stephen, age 20

"About 6 months after our wedding, I discovered a lump on my testicles when I was in the shower. Needless to say, I was very concerned, and I scheduled an appointment with my doctor the next day. Within 3 weeks, I was having an orchiectomy. After that, my doctor said that my cancer was at an early stage and that I was very lucky to have found it because the lump wasn't very big. He told me that I could either have radiation therapy, chemotherapy, or wait and see if I was cured. I decided to wait and see. That was 2 years ago. Last week, my doctor found something on my CT scan that didn't look right. As it turns out, my cancer has come back. So now I'm going to have to have radiation therapy anyway. I wish I had just gotten it over with 2 years ago rather than going through all the checkups and tests, and worrying about it all this time."

— Randall, age 29

"Around 4 years ago, I found a lump on my testicles. After being diagnosed with early-stage seminoma testicular cancer, I decided to do chemo right away rather than surveillance or radiation therapy. My doctor told me that the type of chemo I got doesn't carry the same risk of getting another kind of cancer later in life. I know that there is still a small chance of being infertile from the chemotherapy. But to me it's an acceptable risk. My testicular cancer has been cured, and I feel great."

— Adolfo, age 32

"When I was 29, I was diagnosed with stage I seminoma testicular cancer. At the time, I was told that my cancer was found at a very early stage and that I could either choose radiation or surveillance after orchiectomy. I decided to go with radiation therapy, because I wanted my cancer to be cured as soon as possible. At the age of 46, I was diagnosed with leukemia, which my doctor says could be a result of the radiation therapy I received during treatment for testicular cancer. There's no way to be sure that it's what caused my leukemia. But now I wish I had thought about a surveillance program a little more seriously."

— Jeff, age 49

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I want surveillance, since I might not need more treatment.

         
Not important
Somewhat important
Very important

I want radiation or chemo for the best chance of cure at the start.

         
Not important
Somewhat important
Very important

I'd rather have side effects from treatment than have surveillance.

         
Not important
Somewhat important
Very important

I can make sure I go to checkups and tests during surveillance.

         
Not important
Somewhat important
Very important

I don't mind banking my sperm to have treatment.

         
Not important
Somewhat important
Very important

My other important reasons:

 
         
Not important
Somewhat important
Very important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surveillance

NOT using surveillance

             
Leaning toward
Undecided
Leaning toward

Radiation treatment

NOT having radiation treatment

             
Leaning toward
Undecided
Leaning toward

Chemotherapy

NOT having chemotherapy

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Which treatment means having the most checkups and tests during the first few years?

  • Surveillance
  • Radiation
  • Chemotherapy
  • I'm not sure
You're right. Surveillance requires an intense schedule of frequent checkups and tests.

2. If you're worried that treatment will leave you infertile, can you bank your sperm ahead of time?

  • Yes
  • No
  • I'm not sure
That's right. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology

References
Citations
  1. National Cancer Institute (2012). Testicular Cancer Treatment PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional.

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