What is stage I seminoma testicular cancer?
Testicular cancer is a disease involving the uncontrolled growth of cells
on or inside the testicles, or testes.
There are two main types of
testicular cancer: seminoma and nonseminoma germ-cell tumors (or NSGCTs).
Seminoma tumors tend to respond well to radiation therapy. NSGCTs usually
require chemotherapy or other treatment. Seminomas are also less likely to
spread (metastasize) to the lungs, liver, and brain.
testicular cancers are those that are believed to be confined to the testes. In
some cases, they may have spread to the
lymph nodes of the lower back (retroperitoneum) but
Unlike many other kinds of cancer, most
testicular cancers are slow-growing and respond well to common treatments
(adjuvant therapies) such as
radiation therapy. But adjuvant therapies may cause
both short- and long-term side effects.
What are the treatment options for stage I seminomas?
Following orchiectomy, some stage I seminomas may be treated with
radiation therapy, chemotherapy, or watchful waiting. (Chemotherapy for stage I
seminoma is used mainly in Europe. But this type of medicine is available in
the United States.)
- Radiation therapy.
Radiation is a common treatment for seminomas at all stages of the disease.
Because the lymph nodes in the pelvis and lower back are the most common areas
of metastasis for testicular cancers, radiation is often focused on that area.
During the early phases of stage I seminoma testicular cancer, it can be very
difficult to tell whether these lymph nodes are cancerous, which is why
radiation may be used even when no cancer can be seen. Radiation therapy can
cause long-term health conditions including infertility and an increased chance
of developing cancer later in life. But this is uncommon.
- Chemotherapy. Chemotherapy is the use of
very powerful medicine that kills cancer cells.
Carboplatin is considered a good choice for stage I
seminoma. This is because its side effects are not as bad as some chemotherapy
drugs, and it works well.1
- Watchful waiting. This means you are being monitored closely
by your doctor but are not receiving active treatment. You have a minimum of
one CT scan every 3 months for 2 years following orchiectomy, along with
frequent physical exams and blood tests. If no recurrent cancer is found, the
number of CT scans needed will gradually drop to about one a year after 4 to 7
years and should not be needed after 10 cancer-free years. This follow-up work
can be difficult for some men to do. About 25% of men (1 out of 4) who choose
watchful waiting for stage I seminomas develop cancer within 3 to 4 years and
In some cases of stage I disease, it has been shown that
other treatment following surgery (adjuvant therapy) is not needed following
orchiectomy because the cancer has not spread beyond the testes. Also, even
when cancer is discovered after a period of watchful waiting, it is often
easily cured if the follow-up schedule has been followed closely. Because of
this, many doctors think watchful waiting is a legitimate treatment option for
some men with stage I testicular cancers.
What are the risks of radiation therapy?
therapy for testicular cancer has side effects. Most are short-term and do not
pose any serious health threat. Other side effects, although uncommon, can
permanently affect your lifestyle and health. The most serious long-term risks
linked to radiation therapy for testicular cancer include:
- Infertility. Radiation
may cause permanent infertility in some men. Because many men diagnosed with
testicular cancer are younger than 35, fertility issues are often important in
making treatment decisions. Although most radiation treatment programs do not
permanently affect healthy sperm counts, many doctors recommend sperm banking
before orchiectomy for those men who may wish to have children.
- Secondary cancer. Cancers resulting from
radiation therapy may include leukemia, as well as cancers of the colon,
bladder, kidneys, and prostate. Radiation therapy, although focused on cancer
cells, also exposes many of the body's healthy cells to harmful radiation.
Because many men who have successful treatment for testicular cancer go on to
live for decades, damage to the body's healthy cells caused by radiation may
not become apparent until many years after treatment is completed.
What are the risks of chemotherapy?
affects rapidly growing cells in your body. Besides cancer cells, this includes
blood cells, hair cells, and the cells that line your digestive tract. Common
short-term side effects include nausea and vomiting, hair thinning or hair
loss, mouth sores, diarrhea, and an increased chance of bleeding and infection.
Many men do not have problems with these side effects. Other men have a great
deal of difficulty. If you have problems, your doctor can use other medicines
to help relieve some of these side effects.
Side effects of
- Decreased white blood counts. Red blood cell
counts and platelet counts can also be reduced.
- Nausea, vomiting,
and loss of appetite.
- Diarrhea or
- Numbness and tingling in the hands or feet
- Hearing changes or hearing
- Mild rash.
- Hair loss. This is reversible, and
hair will grow back when treatment ends.
- Mouth sores
- Changes in kidney and liver function tests.
You may not be able to father children after taking
carboplatin. Discuss fertility with your doctor before starting treatment.
Carboplatin can cause birth defects. Do not use this medicine if
you wish to father a child while you are taking it.
Do not use
this medicine if you have:
What are the risks of watchful waiting?
the greatest risk of choosing watchful waiting for testicular cancer has to do
with missing your follow-up tests and exams. Without regular testing and
check-ups, you can miss recurrent cancer until it spreads beyond the lymph
nodes and is more difficult to cure.
If you choose watchful
waiting, it is very important to strictly follow your doctor's schedule of
tests and exams.
About 25% of men (1 out of 4) who choose
watchful waiting instead of radiation therapy following orchiectomy will have
their cancer return.3 In most cases, the recurrent
cancer is confined to lymph nodes in the lower back and pelvis and can be
successfully treated if the follow-up schedule has been closely followed and
the cancer is discovered when it first appears. But cancer that reappears
during watchful waiting may require treatment with more aggressive therapy
(including chemotherapy or radiation) than if radiation therapy had been chosen
immediately following orchiectomy.
Watchful waiting is a
reasonable choice for many men with stage I seminoma testicular cancer. But a
successful watchful waiting program depends on diligent follow-up care by you
and your doctor.