Is further treatment required after removal of a testicle (orchidectomy)?

Whether or not further treatment is required depends on the results of microscopic examination of the testicle (whether the tumour is a seminoma or non-seminoma), levels of testicular tumour markers and how far the cancer has spread.

Results from these investigations are used to determine the stage of the tumour, which is in turn used to determine the type, extent and duration of any treatment.

Further treatment may consist of radiotherapy, chemotherapy or further surgery to, for example, remove abdominal lymph nodes. In many cases, however, simply removing the testicle, accompanied by ‘watchful waiting’, is sufficient.

At our clinic, the precise procedure will be discussed for each patient individually by an interdisciplinary tumour board, involving experts from a number of relevant specialities. The tumour board will put together an individual treatment plan. Interdisciplinary collaboration is essential for ensuring that the patient receives the best possible treatment.

Chemotherapy

Chemotherapy is aimed at killing any remaining cancer cells in the body. It is used for both seminomas and non-seminomas. The doctor or tumour board will usually decide which chemotherapy drug to use and how many treatments (cycles) are required. Chemotherapy can be administered as either an outpatient or inpatient procedure. Following chemotherapy, it may also be necessary to surgically remove the lymph nodes in the rear of the abdomen, a procedure known as a retroperitoneal lymph node dissection.

Retroperitoneal lymph node dissection

This is the surgical removal of lymph nodes at the rear of the abdomen. It is mainly used for non-seminomas to determine whether there are active cancer cells in the lymph nodes. The procedure can be performed either before chemotherapy (diagnostic retroperitoneal lymph node dissection) or following chemotherapy to check for remaining cancer cells.
At our clinic we carry out this operation under a general anaesthetic using both open surgery and keyhole surgery (laparoscopy) techniques. Minimally invasive keyhole surgery has the advantage that patients only have to stay in hospital for a few days (around 3–5 days) and that it leaves only a small scar on the abdomen.

Radiotherapy

In the past, radiotherapy treatment of the retroperitoneal lymph nodes was often performed as a precautionary measure, particularly for seminomas. Nowadays, however, this is rarely recommended, as long-term studies have shown that this has adverse effects on various organ systems and leads to a 20% increase in the incidence of secondary tumours. Radiotherapy can, however, still be an appropriate treatment option in some cases.