Surgery for testicular cancer
Surgery is most often the first treatment for testicular cancer.
Radical inguinal orchiectomy
All stages of testicular cancer are treated with this surgery. The testicle (or testicles) with cancer are taken out of the scrotum through a cut (incision) made just above the pubic area. The surgeon cuts through the spermatic cord that attaches the testicle to the belly (abdomen).
Retroperitoneal lymph node dissection (RPLND)
Depending on the type and stage of your cancer, some lymph nodes at the back of the belly (abdomen) may also be removed. This can be done at the same time as the orchiectomy or during a second operation. Not all patients with testicular cancer need to have lymph nodes removed, so it’s important to discuss this with your doctor.
This is a complex and long operation. A large cut (incision) down the middle of the belly is often needed to remove the lymph nodes. It should be done by a surgeon who does this often.
In some cases, the surgeon can remove lymph nodes through very small cuts in the belly. A narrow lighted tube with a small video 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 this type of surgery has advantages — for example, the patient recovers much more quickly — doctors are not sure if it is as good as the standard operation. So if the removed lymph nodes have cancer cells, 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.
Possible risks and side effects of surgery
The short-term risks of surgery include problems with anesthesia, bleeding, blood clots, and infections. Most men have some pain after the operation, which can often be helped with pain medicines, if needed.
Effects of orchiectomy: Losing a testicle usually does not affect a man’s ability to have sex. But if both testicles are removed, the man can’t make sperm cells and becomes infertile. Also, without testicles, a man can’t make enough testosterone, which can lower sex drive and the ability to have erections. Other effects could include feeling tired, hot flashes, and loss of muscle mass. These side effects can be avoided by taking testosterone, either in the form of a gel, a patch, or a shot.
Most men with testicular cancer are young, and they might be concerned about their appearance after the loss of a testicle. To restore a more natural look, a man can have a testicular implant filled with saline (salt water) put in his scrotum. When in place, it can look like a normal testicle.
Effects of RPLND: Surgery to remove the lymph nodes is a major operation. Serious problems are not common, but they can happen. Some patients have bowel problems or infections after surgery. The standard approach for an RPLND uses a large cut in the abdomen. This leaves a scar and can take some time to heal. This is less likely to be an issue if the surgery is done with a laparoscope, which uses smaller cuts.
This type of surgery does not affect a man’s ability to have sex. But it might damage some of the nerves that control the release of semen, which can make it hard to father children. Some surgeons do a type of lymph node surgery called nerve-sparing surgery that can often help with this. Men who might want to have children at some point may wish to discuss nerve-sparing surgery with their doctors, as well as sperm banking (freezing and storing sperm cells obtained before treatment). Men with testicular cancer often have lower than normal sperm counts, which can sometimes make it hard to collect a good sperm sample. See our document Fertility and Men With Cancer to find out more about this.
Last Medical Review: 01/02/2014
Last Revised: 01/09/2015