Testicular Cancer: Surgery
Surgery is typically the first treatment for testicular cancer. Different kinds of surgery may be done. Which type you have depends on the type of testicular cancer, how much it has spread, and other factors. You might also need other treatments after surgery. These might be chemotherapy or radiation therapy.
When might surgery be used for testicular cancer?
Just about all men with testicular cancer will have surgery to remove the testicle with the cancer. In fact, this is typically how the diagnosis of testicular cancer is confirmed. If there is a reasonable chance that the cancer might have spread to lymph nodes in the back of the abdomen, these lymph nodes will also be removed. This is often done as a separate operation.
Types of surgery for testicular cancer
Two main types of operations are done to treat testicular cancer:
Radical inguinal orchiectomy
For this operation, the surgeon makes a cut just above your pubic area. He or she takes out your testicle through the inguinal canal. The surgeon cuts the spermatic cord, which connects the testicle to your abdomen. The surgeon removes your testicle along with the tumor. He or she pays careful attention to avoid spreading the cancer cells during the removal process. If you have cancer in both of your testicles, the surgeon removes them both.
Your surgeon will not remove your scrotum. If you wish, you can have your doctor insert an artificial testicle at a later time.
Retroperitoneal lymph node dissection (RPLND)
Depending on the stage of the cancer, the surgeon may also take out lymph nodes behind the abdomen. This surgery is most often done separately at a later time. But sometimes it can be done at the same time the testicle with the tumor is removed. This operation can be done using either a long incision or several smaller incisions. Through the smaller incisions, the surgeon can use long, thin surgical instruments to reach into the retroperitoneal cavity. The surgeon also uses a tiny video camera that displays onto a monitor. This is known as laparoscopic surgery. The long incision approach can sometimes be a longer operation and might take more time to recover from. But doctors aren't sure that the laparoscopic approach is as safe in removing all the cancerous lymph nodes. Your doctor will discuss which approach is better for you and why. An RPLND is a difficult surgery. It should be done by a skilled surgeon who has a lot of experience with this type of surgery.
Risks and possible side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Reactions to anesthesia
Blood clots in the legs or lungs
Damage to nearby organs
Here are some other possible side effects that men with testicular cancer can have after surgery. Ask your doctor which ones are most likely to happen to you:
Pain in the area where the tumor was removed or near the incision. This can usually be controlled with medicine.
Less fertility. If you might want to have children in the future, talk with your doctor about saving a sample of your sperm before surgery. This is called sperm banking.
Damage to your nerves that can leave you unable to ejaculate. The medical name for this is retrograde ejaculation. This is most common in men who have had a retroperitoneal lymph node dissection. This type of surgery does not affect a man's ability to have erections. Newer, nerve-sparing surgical techniques can help avoid this side effect.
Being unhappy with the altered appearance of your scrotum. If this is an issue, talk with your doctor about testicular implants.
Slower than normal healing
Inability to drive, lift, or do other daily activities until you heal
Depression or anxiety
If both of your testicles are removed, you will no longer be able to make sperm, so you will be infertile. Your body will also not make enough male hormones (androgens) such as testosterone. You will need to take hormone supplements.
Although the side effects of surgery cannot be completely avoided, your healthcare team can offer many tips to make your recovery from surgery as smooth as possible.
Getting ready for your surgery
Before you go for surgery, you will talk with your surgeon about the procedure. This is a good time to ask any questions you have and discuss any concerns. You might ask if the surgery will leave scars and what those scars will look like. If you want to have children in the future, you should talk with your doctor about how the surgery could affect your fertility. Many men decide to save a sample of their sperm before treatment for testicular cancer. This is called sperm banking. If the treatment makes you infertile, you and your partner could use this sperm to try to have a child. Discuss this choice with your doctor if it is a concern.
After you have discussed all the details with the surgeon, you will sign a consent form. This give the surgeon permission to do the surgery.
You will also talk with an anesthesiologist or a nurse anesthetist. This is the health care provider who will give you the general anesthesia, the medicine that prevents pain and makes you sleep during surgery. He or she also monitors you during surgery to keep you safe. He or she will ask about your health history and your medicines.
What to expect during surgery
On the day of surgery, you will be taken into the operating room. Your health care team will include the anesthesiologist, the surgeon, and nurses.
During a typical surgery:
You will be moved onto the operating table.
The anesthesiologist or nurse will place an IV line into your arm. Sometimes the IV may be started in the preoperative area instead.
The staff will put ECG wires with small, sticky pads on your chest. These are to keep track of your heart rate. They will put a blood pressure cuff around your arm.
You will get the anesthetic through the IV and will fall asleep.
What is removed during surgery and where your incisions are depend on the type of surgery you have.
What to expect after surgery
You will wake up in a recovery room. You will be watched closely by healthcare providers. You will be given medicine to treat pain. You may be able to go home the same day. Or you might have to stay in the hospital overnight.
If you had an orchieectomy, you may be told to keep ice on your scrotum and wear an athletic supporter to keep the swelling down for a few days. You might need to stay fairly inactive for a few days after you leave the hospital. But you can gradually return to most activities.
You should avoid lifting heavy things for several weeks. Always follow the instructions you get from your doctor or nurse.
After surgery, you may feel weak or tired for a while. The amount of time it takes to recover from an operation is different for each person. But you will probably not feel like yourself for a while. You likely won't be able to drive for a while, as directed by your healthcare providers.
After surgery, you may have chemotherapy or radiation to reduce the chance that any remaining cancer cells will spread. These are called adjuvant therapies.
March 21, 2017
Patient information: Testicular cancer (Beyond the Basics). UpToDate.
Alteri, Richard, MD,MMI board-certified, academically affiliated clinician