Chemotherapy for testicular cancer

Chemotherapy (chemo) is the use of drugs for treating cancer. The drugs can be swallowed in pill form, or they can be injected by needle into a vein or muscle. To treat testicular cancer, the drugs are usually given into a vein. Chemo is considered systemic therapy. This means that the drug enters the bloodstream and circulates throughout the body to reach and destroy the cancer cells. Chemo is an effective way to destroy any cancer cells that break off from the main tumor and travel in the bloodstream to lymph nodes or distant organs.

Chemo is often used to cure testicular cancer when it has spread outside the testicle or to decrease the risk of cancer coming back after the testicle is removed. It is not used to treat the cancer that is only in the testicle.

Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Using 2 or more chemotherapy drugs is often more effective than using any single drug. The main drugs used to treat testicular cancer are:

• Cisplatin
• Vinblastine
• Bleomycin
• Cyclophosphamide (Cytoxan^®)
• Etoposide (VP-16)
• Paclitaxel (Taxol^®)
• Ifosfamide (Ifex^®)

These drugs are used in various combinations. The chemotherapy regimens most commonly used as the initial treatment for testicular cancer are bleomycin, etoposide, and cisplatin (called BEP or PEB), or etoposide and cisplatin (also known as EP). Another combination that may be used is called VIP and includes the drugs VP-16 (etoposide) or vinblastine plus ifosfamide and cisplatin. Some doctors believe that a more intensive regimen should be used for patients with high-risk disease, and may suggest a different combination of chemotherapy drugs or even a stem cell transplant (see next section).

Possible side effects

Chemo drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to certain side effects.

The side effects of chemo depend on the type and dose of drugs used and how long they are given. These side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Increased chance of infections (due to low white blood cell counts)
• Easy bruising or bleeding (due to low blood platelet counts)
• Fatigue (due to low red blood cell counts)

Some of the drugs used to treat testicular cancer can have other side effects. For example, cisplatin can cause kidney damage. This can be lessened by giving lots of fluids (usually into a vein – IV) before and after the drug is given. Cisplatin, etoposide, paclitaxel, and vinblastine can damage nerves (known as neuropathy). This can lead to hearing loss, numbness or tingling sensations in the hands or feet, and sensitivity to cold or heat. In most cases this goes away once treatment is stopped, but it may last a long time in some people. Bleomycin can damage lungs, causing shortness of breath and trouble with physical activity. Ifosfamide can cause the bladder to bleed (called hemorrhagic cystitis). To prevent this, a drug called mesna is given along with ifosfamide.

Most side effects are short-term and go away after treatment is finished, but some can last a long time and may never go away completely. You should report any side effects or changes you notice while getting chemotherapy to your medical team so that you can get prompt treatment for them. There are often ways to prevent or lessen side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

Some of the drugs used to treat testicular cancer can cause long term side effects. These include some of the things mentioned earlier, like hearing loss and kidney damage, Development of a second cancer (like leukemia) is a very serious but fortunately, a rare side effect of chemo. It occurs in less than 1% of testicular cancer patients treated with chemo. People who have had chemo for testicular cancer seem to have a higher risk of heart problems later in life. Several studies have also suggested that this chemotherapy treatment can sometimes cause high blood cholesterol to develop over time, which may later require treatment.

For more information about chemotherapy and its side effects, please our document called Understanding Chemotherapy: A Guide for Patients and Families.