Chemotherapy for Testicular Cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs can be taken by mouth, or they can be injected by needle into a vein or muscle. To treat testicular cancer, the drugs are usually given into a vein (IV). Chemo is absorbed into the bloodstream and goes throughout the body to destroy cancer cells.

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

Chemo drugs used to treat testicular cancer

Chemo is given in cycles that generally last about 3 to 4 weeks. Each period of treatment is followed by a rest period to allow the body time to recover.

Using 2 or more chemo drugs often works better than using any single drug alone. The chemo regimens most used as the first treatment for testicular cancer are:

• BEP: bleomycin, etoposide, and cisplatin
• Carboplatin (for stage I pure seminoma only)
• EP: etoposide and cisplatin
• TIP: paclitaxel, ifosfamide, and cisplatin
• VeIP: vinblastine, ifosfamide, and cisplatin
• VIP: VP-16 (etoposide), ifosfamide, and cisplatin
• High-dose carboplatin and etoposide
• Gemcitabine, paclitaxel, and oxaliplatin

Some doctors use more intensive plans for patients with high-risk disease and may suggest a different combination of chemo drugs or even a stem cell transplant.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. However, other cells in the body, such as those in the bone marrow (where new blood cells are made), 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
• Diarrhea
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (extreme tiredness, often from having too few red blood cells)

Some of the drugs used to treat testicular cancer can have other side effects. For example:

• Cisplatin and ifosfamide can cause kidney damage. This can be lessened by giving lots of fluids (usually into a vein) before and after these drugs are given.
• Cisplatin, etoposide, paclitaxel, and vinblastine can damage nerves (known as neuropathy). This can lead to numbness or tingling in the hands and feet, and sensitivity to cold or heat. In most cases, this gets better once treatment is stopped, but it may last a long time in some people.
• Cisplatin can also cause loss of hearing, called ototoxicity.
• Bleomycin can damage the lungs, causing shortness of breath and trouble with physical activity.
• Ifosfamide can cause the bladder to bleed, called hemorrhagic cystitis. To prevent this, the patient is given plenty of fluids, and the drug mesna is given along with ifosfamide.

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

Possible long-term side effects

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 or lung damage. Development of a second cancer (like leukemia) is a very rare but serious side effect of chemo, occurring in less than 1% of testicular cancer patients treated with chemo. People who've had chemo for testicular cancer seem to have a higher risk of heart problems later in life. Several studies have also suggested that chemo can sometimes cause high blood cholesterol to develop over time, which may later require treatment.