Surgery for testicular cancer

Surgery is most often the first treatment for testicular cancer.

Radical inguinal orchiectomy

For most cancers, a biopsy is done before surgery to remove a tumor (a biopsy is when a sample of the tumor is removed and looked at under a microscope to see if it is cancer or something else). But since a tumor in the testicle is likely to be a cancer, biopsies are rarely done for testicular cancer. If a solid mass (tumor) is seen on ultrasound, it is treated like a cancer and removed with surgery.

All stages of testicular cancer are treated with surgery. The testicle (or testicles) with cancer are taken out of the scrotum through a cut (incision) in the groin. The surgeon also cuts through the spermatic cord that attaches the testicle to the belly (abdomen). This is known as a radical inguinal orchiectomy. If both testicles are removed, the man can no longer make sperm cells and can no longer father children (he becomes infertile).

Retroperitoneal lymph node dissection

Depending on the type and stage of your cancer, some lymph nodes behind the belly (abdomen) may also be removed. This can be done at the same time or during a second operation. This operation is called a retroperitoneal lymph node dissection. A large cut (incision) is often needed to remove these lymph nodes. This is a difficult and long operation. It should be done by a surgeon who does them often.

In some cases, the surgeon can remove lymph nodes through very small cuts in the belly. A narrow lighted tube with a camera (called a laparoscope) is used so the surgeon can see inside. Long, thin tools are put in the cuts to do the surgery. The surgeon's hands are not inside the patient's body during surgery. Although there are advantages to this type of surgery-- for example, the patient recovers much more quickly-- there is not yet agreement about whether it is as good as the standard operation. That is why if the lymph nodes removed contain cancer, the patient is often treated with chemotherapy, as well. This approach should only be used if the surgeon has a lot of experience with this surgery.

How treatment can affect sexuality

Surgery to remove lymph nodes behind the belly can damage nearby nerves that control sexual climax (ejaculation). If these nerves are damaged, when a man has a climax the sperm do not go out of the body. Instead, they go into the bladder. Damage to these nerves does not affect a man's being able to have an erection but can make it harder for him to father children. To avoid this problem, surgeons use a nerve-sparing approach to this surgery that has a very high rate of success when done by a doctor with a lot of experience.

If both testicles are removed a man cannot make sperm cells and he becomes infertile. Also his body will no longer make enough testosterone. He will need to take supplements, either in the form of a gel, patches, or a shot. As a rule, testosterone pills don't work.

Testicular cancer often affects men at an age when they are trying to have children. These men may wish to talk about nerve-sparing surgery with their doctors. They may also want to talk about storing frozen sperm cells before treatment (sperm banking). Men with testicular cancer often have lower than normal sperm counts, which may make sperm banking hard. You should talk about this with your doctor when making treatment choices.

When a testicle is removed, that side of the scrotum can look and feel empty. Men with testicular cancer are usually young. They may be single and dating. Or they may be athletic and feel embarrassed by the missing testicle when in locker rooms. A man can have an artificial testicle (prosthesis) placed in his scrotum to give a more natural look. The prosthesis approved for use in the United States is filled with salt water (saline). It comes in many sizes to match the other testicle. It can look much like a normal testicle. There may be a scar after the surgery, but it is often partly hidden by pubic hair. Some men want to have prosthesis and others do not. You should discuss your wishes with your surgeon as you think about this surgery. It may also help to talk with someone who has had a testicular prosthesis, to see what their experience was like.

Losing a testicle usually has no effect on a man's ability to get an erection and have sex. Men who have had both testicles removed are also still able to have sex as long as they are getting enough testosterone.