Chemotherapy 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. Chemotherapy is considered systemic therapy. This means that the drug enters the bloodstream and circulates throughout the body to reach and destroy the cancer cells. Chemotherapy 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.

Chemotherapy 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. Chemotherapy 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
• etoposide
• paclitaxel
• ifosfamide

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 etoposide and cisplatin (also known as EP). 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

Chemotherapy 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 chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs you are given and for how long. 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)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

Some of the drugs used to treat testicular cancer can cause long-term side effects. Cisplatin can cause kidney damage. It can also damage nerves, causing hearing loss, numbness or tingling sensations in the hands or feet, and sensitivity to cold or heat. (This is called peripheral neuropathy.) 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. You should report these, as well as any other side effects or changes you notice while getting chemotherapy, to your medical team so that you can get prompt treatment for them. 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.

Development of a second cancer (usually leukemia, related to etoposide) is a very serious but fortunately, a rare side effect. It occurs in less than 1% of testicular cancer patients treated with chemotherapy. People who have had chemotherapy 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 see the American Cancer Society document, Understanding Chemotherapy: A Guide for Patients and Families.

Last Medical Review: 08/03/2009
Last Revised: 08/03/2009