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

Testicular Cancer: Which Treatment Should I Have for Stage I Nonseminoma 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 Nonseminoma 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 surgery, you and your doctor must decide what to do next. For stage I nonseminoma testicular cancer, these are your choices:

  • Have surveillance . This means following a schedule of regular checkups and tests.
  • Have chemotherapy . It can kill any stray cancer cells.
  • Have surgery to remove the lymph nodes in your pelvis and lower back.

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

Key points to remember

  • Testicular cancer is highly curable. Even when the cancer comes back (recurs), it can almost always be treated successfully.
  • Stage I nonseminoma cancer is either high-risk or low-risk. Tests done 6 to 8 weeks after surgery to remove the testicle will show what your risk is.
  • For low-risk cancer, most experts agree that surveillance is the preferred option. For high-risk cancer, experts disagree. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.
  • Lymph node surgery and chemotherapy have some serious risks and side effects. Choosing surveillance lets you avoid these risks and side effects. Or it will let you put them off for a while. But if you choose surveillance and the cancer comes back, you will need a higher dose of chemotherapy to treat it. A higher dose has more risk for serious side effects.
  • About 70 out of 100 men who choose surveillance after surgery have been cured by the surgery and don't need more treatment. This means that about 30 of those 100 men do need treatment later. 1 But the chances of your cancer coming back will depend on whether it is low-risk or high-risk.
  • 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 nonseminoma testicular cancer?

There are two main types of testicular cancer: seminoma and nonseminoma. Nonseminomas often grow and spread more quickly than seminomas. Nonseminomas also are more likely to spread to the lungs, liver, and brain.

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

Both seminoma and nonseminoma 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 nonseminoma testicular cancer?

The first treatment is surgery to remove the testicle. After 6 to 8 weeks, tests will be done to find out if your cancer is low-risk or high-risk. Some men who choose surveillance will need more treatment. But any of the three choices will cure the cancer in about 99 out of 100 men with nonseminoma cancer. 1

For men with low-risk (stage IA) nonseminoma, cancer comes back in about 20 to 30 out of 100 men. 2 Most experts agree that surveillance is the preferred option for low-risk nonseminoma.

For men with high-risk (stage IB) nonseminoma, cancer comes back in about 50 out of 100 men. 2 Experts disagree on the best treatment for high-risk nonseminoma. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.

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 lymph node surgery or chemotherapy.

Even when cancer is found after a period of surveillance, it is almost always possible to cure if it's found early. Because of this, most experts consider surveillance the preferred option for men with low-risk cancer.

Chemotherapy

Chemotherapy, often called "chemo," is the use of very strong drugs to kill cancer cells.

A short course of chemo has been designed for stage I nonseminoma cancer, especially for men who have high-risk cancer. Several medicines are used.

Lymph node surgery

The full name for this surgery is retroperitoneal lymph node dissection (or RPLND). It is surgery to remove lymph nodes in the lower back and pelvis. These lymph nodes may contain cancer.

During the early phases of the cancer, it can be very hard to tell if these lymph nodes have cancer without taking them out. In the past, doing this often caused infertility. Modern nerve-sparing methods have greatly lowered the chances of infertility.

Having this surgery isn't routine treatment for stage I nonseminoma. But if you and your doctor decide that this treatment is the best option for you, think about having it done at a hospital where many of these surgeries are done.

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.

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

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 chemotherapy than if you'd had it soon after your surgery.

What are the risks of chemotherapy?

Chemotherapy for testicular cancer has caused permanent infertility in some men. Because most men diagnosed with this cancer are younger than 35, this is important to think about when you choose which treatment to use.

Some men still need surgery after chemo to remove damaged tissue or remaining cancer. In those cases it is not always possible for the surgeon to use nerve-sparing methods that greatly reduce the chances of infertility.

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

Side effects of chemo

Common short-term side effects include:

  • Nausea and vomiting.
  • Hair thinning or hair loss.
  • Mouth sores.
  • Diarrhea.
  • A higher chance of bleeding and infection.

The chemo used for testicular cancer has also been linked with serious long-term side effects. These side effects may include:

  • High blood pressure.
  • Increased cholesterol levels.
  • Kidney, heart, and lung damage.
  • Increased risk of other cancers, such as leukemia .

What are the risks of lymph node surgery?

The risks and side effects of lymph node surgery for testicular cancer include:

  • Chylous ascites. With this condition, fluids collect inside the belly. This may cause belly pain and make it hard to breathe.
  • Lymphedema. This is a collection of fluid that causes swelling in the arms, legs, and genitals.
  • Bleeding.
  • Pulmonary embolism. This is a sudden blockage of blood flow in the lung.
Fertility problems after surgery

Men who get lymph node surgery can end up with nerve damage that causes retrograde ejaculation. This means that the semen flows up into the bladder instead of out through the penis. This makes you unable to father children.

In most cases, men with retrograde ejaculation don't have erection problems or trouble enjoying sex.

Nerve-sparing methods have greatly lowered the risk of retrograde ejaculation. Nerve-sparing surgery may be more difficult or impossible for men who have had chemotherapy. Talk to your doctor about whether nerve-sparing surgery is an option for you.

General surgery risks

Like any major surgery, the risks include:

  • Pain after surgery. Your doctor may give you a prescription for pain medicine or have you try over-the-counter pain medicine.
  • Reactions to anesthesia or medicines.
  • Infection.
  • Bleeding.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Try surveillance Try surveillance
  • You have frequent checkups, X-rays, blood tests, and CT scans during the first few years.
  • You will need checkups and testing less often as the years go by and your cancer doesn't come back.
  • More than 99 out of 100 men who choose surveillance are cured. But 30 out of 100 men will need more treatment. 1
  • It can be hard to follow the long and intense schedule of checkups and tests that are required with surveillance.
  • The cancer is more likely to come back with surveillance.
Have chemotherapy Have chemotherapy
  • The chemotherapy drug is usually injected into a vein in your hand or arm. This method is called an IV.
  • You may get chemotherapy during a hospital stay, at a clinic, or in a hospital's outpatient unit.
  • You may have treatments over the course of 3 months.
  • More than 99 out of 100 men who have chemo are cured. 1
  • Side effects of chemotherapy can include nausea and vomiting, hair loss, mouth sores, and diarrhea.
  • You may need surgery to remove damaged tissue or remaining cancer after chemotherapy.
  • Chemotherapy can cause serious long-term health problems, including secondary cancers. These cancers may not appear until many years after treatment.
  • Chemotherapy causes infertility in some men.
Have lymph node surgery Have lymph node surgery
  • If you have surgery, the doctor makes a long cut in your belly, from the breastbone to the pubic bone.
  • You are asleep during the operation.
  • The hospital stay is usually 4 to 8 days for surgery.
  • Recovery from surgery takes 6 to 12 weeks.
  • More than 99 out of 100 men who have lymph node surgery are cured. 1
  • You can avoid having chemotherapy.
  • Even with nerve-sparing techniques, some men will become infertile after surgery.
  • Nerve-sparing surgery is not possible for some men.
  • Like all major surgeries, lymph node surgery has risks, including infection, bleeding, and blood clots.

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 RPLND (lymph node surgery), chemotherapy, or surveillance for stage I nonseminoma

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

After I got over the shock of my diagnosis, we talked about my treatment choices. My doctor told me that because we caught the cancer at an early stage, I had to decide on which treatment option was best for me. After discussing it with my wife, we decided on the RPLND. We also felt the stress of surveillance would be just too much for us, especially since we have a young child and would like to have another. My doctor says that I'm still cancer-free after 2 years, but the surgery did cause me to become infertile. Although I did bank sperm before the surgery, part of me wishes I had given more thought to surveillance.

Lorenzo, age 37

When my doctor told me I had testicular cancer, I was devastated. I decided that I would do everything in my power to beat this disease. After discussing it with my doctor I decided to go ahead with chemotherapy. I knew there was a chance that I didn't need it, but I wanted to get it over with as soon as possible so I could continue with my life. Because my cancer was early-stage, the chemotherapy program wasn't very intensive. And the side effects were barely noticeable. That was a year ago, and I feel great. I know I made the right decision for me.

Michael, age 31

At first I couldn't believe what the doctor was telling me. How could I have cancer? I thought I was too young for something like that. After going through a period of denial and anger, I decided I was going to do whatever I could to beat it. My doctor said I was fortunate because we had caught it at an early stage. After orchiectomy, I was told I could either go for surgery to remove lymph nodes in my pelvis, have chemotherapy, or try surveillance. I decided to wait and see if my cancer was gone before having other treatment. I'm young and don't like the idea of having major surgery or chemotherapy if I don't have to, especially since they can cause other problems later on. The follow-up schedule has been hard to stick to at times. But it's been over a year, and the doctor says I'm still cancer-free, so I think it's been worth it.

Sam, age 20

After being diagnosed with a stage I nonseminoma, I decided to try a surveillance program after my orchiectomy. I made all of my follow-up appointments and felt confident that my cancer was gone for good. Well, about 8 months after I started the program, we found out that my cancer had spread to the lymph nodes in my pelvis. Now my doctor tells me that I'm going to need chemotherapy to cure my cancer. I can't believe that the cancer came back. But my doctor says that my chances are really good that I will be cured. I hope he is right.

David, age 33

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 chemo or lymph node surgery for the best chance of cure at the start.

Not important
Somewhat important
Very important

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

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

Chemotherapy

NOT having chemotherapy

Leaning toward
Undecided
Leaning toward

Surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does surveillance simply mean having a special test during your yearly checkup?

  • Yes Sorry, that's wrong. If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.
  • No You're right. If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.
  • I'm not sure It may help to go back and read "Get the Facts." If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.
2.

Are lymph node surgery and chemotherapy the surest ways to keep cancer from coming back?

  • Yes That's right. They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.
  • No Sorry, that's not right. They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.
  • I'm not sure. It may help to go back and read "Get the Facts." They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.
3.

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

  • Yes That's right. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
  • No Sorry, that's wrong. If you're worried that treatment may leave you infertile, you can bank your sperm ahead of time.
  • I'm not sure It 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.
  2. National Comprehensive Cancer Network (2013). Testicular cancer. NCCN Clinical Practice Guidelines in Oncology, version 1.2013. Available online: http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.
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 Nonseminoma 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 surgery, you and your doctor must decide what to do next. For stage I nonseminoma testicular cancer, these are your choices:

  • Have surveillance . This means following a schedule of regular checkups and tests.
  • Have chemotherapy . It can kill any stray cancer cells.
  • Have surgery to remove the lymph nodes in your pelvis and lower back.

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

Key points to remember

  • Testicular cancer is highly curable. Even when the cancer comes back (recurs), it can almost always be treated successfully.
  • Stage I nonseminoma cancer is either high-risk or low-risk. Tests done 6 to 8 weeks after surgery to remove the testicle will show what your risk is.
  • For low-risk cancer, most experts agree that surveillance is the preferred option. For high-risk cancer, experts disagree. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.
  • Lymph node surgery and chemotherapy have some serious risks and side effects. Choosing surveillance lets you avoid these risks and side effects. Or it will let you put them off for a while. But if you choose surveillance and the cancer comes back, you will need a higher dose of chemotherapy to treat it. A higher dose has more risk for serious side effects.
  • About 70 out of 100 men who choose surveillance after surgery have been cured by the surgery and don't need more treatment. This means that about 30 of those 100 men do need treatment later. 1 But the chances of your cancer coming back will depend on whether it is low-risk or high-risk.
  • 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 nonseminoma testicular cancer?

There are two main types of testicular cancer: seminoma and nonseminoma. Nonseminomas often grow and spread more quickly than seminomas. Nonseminomas also are more likely to spread to the lungs, liver, and brain.

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

Both seminoma and nonseminoma 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 nonseminoma testicular cancer?

The first treatment is surgery to remove the testicle. After 6 to 8 weeks, tests will be done to find out if your cancer is low-risk or high-risk. Some men who choose surveillance will need more treatment. But any of the three choices will cure the cancer in about 99 out of 100 men with nonseminoma cancer. 1

For men with low-risk (stage IA) nonseminoma, cancer comes back in about 20 to 30 out of 100 men. 2 Most experts agree that surveillance is the preferred option for low-risk nonseminoma.

For men with high-risk (stage IB) nonseminoma, cancer comes back in about 50 out of 100 men. 2 Experts disagree on the best treatment for high-risk nonseminoma. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.

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 lymph node surgery or chemotherapy.

Even when cancer is found after a period of surveillance, it is almost always possible to cure if it's found early. Because of this, most experts consider surveillance the preferred option for men with low-risk cancer.

Chemotherapy

Chemotherapy, often called "chemo," is the use of very strong drugs to kill cancer cells.

A short course of chemo has been designed for stage I nonseminoma cancer, especially for men who have high-risk cancer. Several medicines are used.

Lymph node surgery

The full name for this surgery is retroperitoneal lymph node dissection (or RPLND). It is surgery to remove lymph nodes in the lower back and pelvis. These lymph nodes may contain cancer.

During the early phases of the cancer, it can be very hard to tell if these lymph nodes have cancer without taking them out. In the past, doing this often caused infertility. Modern nerve-sparing methods have greatly lowered the chances of infertility.

Having this surgery isn't routine treatment for stage I nonseminoma. But if you and your doctor decide that this treatment is the best option for you, think about having it done at a hospital where many of these surgeries are done.

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.

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

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 chemotherapy than if you'd had it soon after your surgery.

What are the risks of chemotherapy?

Chemotherapy for testicular cancer has caused permanent infertility in some men. Because most men diagnosed with this cancer are younger than 35, this is important to think about when you choose which treatment to use.

Some men still need surgery after chemo to remove damaged tissue or remaining cancer. In those cases it is not always possible for the surgeon to use nerve-sparing methods that greatly reduce the chances of infertility.

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

Side effects of chemo

Common short-term side effects include:

  • Nausea and vomiting.
  • Hair thinning or hair loss.
  • Mouth sores.
  • Diarrhea.
  • A higher chance of bleeding and infection.

The chemo used for testicular cancer has also been linked with serious long-term side effects. These side effects may include:

  • High blood pressure.
  • Increased cholesterol levels.
  • Kidney, heart, and lung damage.
  • Increased risk of other cancers, such as leukemia .

What are the risks of lymph node surgery?

The risks and side effects of lymph node surgery for testicular cancer include:

  • Chylous ascites. With this condition, fluids collect inside the belly. This may cause belly pain and make it hard to breathe.
  • Lymphedema. This is a collection of fluid that causes swelling in the arms, legs, and genitals.
  • Bleeding.
  • Pulmonary embolism. This is a sudden blockage of blood flow in the lung.
Fertility problems after surgery

Men who get lymph node surgery can end up with nerve damage that causes retrograde ejaculation. This means that the semen flows up into the bladder instead of out through the penis. This makes you unable to father children.

In most cases, men with retrograde ejaculation don't have erection problems or trouble enjoying sex.

Nerve-sparing methods have greatly lowered the risk of retrograde ejaculation. Nerve-sparing surgery may be more difficult or impossible for men who have had chemotherapy. Talk to your doctor about whether nerve-sparing surgery is an option for you.

General surgery risks

Like any major surgery, the risks include:

  • Pain after surgery. Your doctor may give you a prescription for pain medicine or have you try over-the-counter pain medicine.
  • Reactions to anesthesia or medicines.
  • Infection.
  • Bleeding.

2. Compare your options

  Try surveillance Have chemotherapy
What is usually involved?
  • You have frequent checkups, X-rays, blood tests, and CT scans during the first few years.
  • You will need checkups and testing less often as the years go by and your cancer doesn't come back.
  • The chemotherapy drug is usually injected into a vein in your hand or arm. This method is called an IV.
  • You may get chemotherapy during a hospital stay, at a clinic, or in a hospital's outpatient unit.
  • You may have treatments over the course of 3 months.
What are the benefits?
  • More than 99 out of 100 men who choose surveillance are cured. But 30 out of 100 men will need more treatment. 1
  • More than 99 out of 100 men who have chemo are cured. 1
What are the risks and side effects?
  • It can be hard to follow the long and intense schedule of checkups and tests that are required with surveillance.
  • The cancer is more likely to come back with surveillance.
  • Side effects of chemotherapy can include nausea and vomiting, hair loss, mouth sores, and diarrhea.
  • You may need surgery to remove damaged tissue or remaining cancer after chemotherapy.
  • Chemotherapy can cause serious long-term health problems, including secondary cancers. These cancers may not appear until many years after treatment.
  • Chemotherapy causes infertility in some men.
  Have lymph node surgery
What is usually involved?
  • If you have surgery, the doctor makes a long cut in your belly, from the breastbone to the pubic bone.
  • You are asleep during the operation.
  • The hospital stay is usually 4 to 8 days for surgery.
  • Recovery from surgery takes 6 to 12 weeks.
What are the benefits?
  • More than 99 out of 100 men who have lymph node surgery are cured. 1
  • You can avoid having chemotherapy.
What are the risks and side effects?
  • Even with nerve-sparing techniques, some men will become infertile after surgery.
  • Nerve-sparing surgery is not possible for some men.
  • Like all major surgeries, lymph node surgery has risks, including infection, bleeding, and blood clots.

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 RPLND (lymph node surgery), chemotherapy, or surveillance for stage I nonseminoma

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

"After I got over the shock of my diagnosis, we talked about my treatment choices. My doctor told me that because we caught the cancer at an early stage, I had to decide on which treatment option was best for me. After discussing it with my wife, we decided on the RPLND. We also felt the stress of surveillance would be just too much for us, especially since we have a young child and would like to have another. My doctor says that I'm still cancer-free after 2 years, but the surgery did cause me to become infertile. Although I did bank sperm before the surgery, part of me wishes I had given more thought to surveillance."

— Lorenzo, age 37

"When my doctor told me I had testicular cancer, I was devastated. I decided that I would do everything in my power to beat this disease. After discussing it with my doctor I decided to go ahead with chemotherapy. I knew there was a chance that I didn't need it, but I wanted to get it over with as soon as possible so I could continue with my life. Because my cancer was early-stage, the chemotherapy program wasn't very intensive. And the side effects were barely noticeable. That was a year ago, and I feel great. I know I made the right decision for me."

— Michael, age 31

"At first I couldn't believe what the doctor was telling me. How could I have cancer? I thought I was too young for something like that. After going through a period of denial and anger, I decided I was going to do whatever I could to beat it. My doctor said I was fortunate because we had caught it at an early stage. After orchiectomy, I was told I could either go for surgery to remove lymph nodes in my pelvis, have chemotherapy, or try surveillance. I decided to wait and see if my cancer was gone before having other treatment. I'm young and don't like the idea of having major surgery or chemotherapy if I don't have to, especially since they can cause other problems later on. The follow-up schedule has been hard to stick to at times. But it's been over a year, and the doctor says I'm still cancer-free, so I think it's been worth it."

— Sam, age 20

"After being diagnosed with a stage I nonseminoma, I decided to try a surveillance program after my orchiectomy. I made all of my follow-up appointments and felt confident that my cancer was gone for good. Well, about 8 months after I started the program, we found out that my cancer had spread to the lymph nodes in my pelvis. Now my doctor tells me that I'm going to need chemotherapy to cure my cancer. I can't believe that the cancer came back. But my doctor says that my chances are really good that I will be cured. I hope he is right."

— David, age 33

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 chemo or lymph node surgery for the best chance of cure at the start.

         
Not important
Somewhat important
Very important

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

         
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

Chemotherapy

NOT having chemotherapy

             
Leaning toward
Undecided
Leaning toward

Surgery

NOT having surgery

             
Leaning toward
Undecided
Leaning toward

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

Check the facts

1. Does surveillance simply mean having a special test during your yearly checkup?

  • Yes
  • No
  • I'm not sure
You're right. If you choose surveillance, you must be willing to follow an intense schedule of frequent checkups and tests.

2. Are lymph node surgery and chemotherapy the surest ways to keep cancer from coming back?

  • Yes
  • No
  • I'm not sure.
That's right. They are the surest ways to keep cancer from coming back at the start of treatment. But with surveillance, even if you need to have treatment later, the cure rates are very high.

3. If you're worried that chemotherapy or surgery 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.
  2. National Comprehensive Cancer Network (2013). Testicular cancer. NCCN Clinical Practice Guidelines in Oncology, version 1.2013. Available online: http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.

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