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Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate in the bloodstream and can reach cancer cells anywhere in the body. The drugs most commonly used to treat testicular cancer are cisplatin, etoposide and bleomycin. They are usually used together, which is known as BEP chemotherapy.
Chemotherapy may be given to men with teratoma, either to prevent the cancer coming back after surgery or to treat any cancer that has spread to the lymph nodes at the back of the abdomen, or elsewhere in the body.
Men with seminoma usually have chemotherapy if there are a lot of cancer cells in the nodes at the back of the abdomen, or if the seminoma has spread beyond these lymph nodes.
The chemotherapy drugs are given by injection into a vein (intravenously). Two to four sessions of chemotherapy are usually given. Each session involves spending a few days in hospital followed by weekly outpatients visits to be given the chemotherapy drugs. If the cancer has spread to other parts of the body, a longer course of chemotherapy may be necessary, or the treatment may be given weekly.
Chemotherapy using a single dose of just one drug (called carboplatin) is given to treat seminoma if the cancer does not seem to have spread. As an alternative, radiotherapy to the nodes at the back of the abdomen may be given.
Chemotherapy may also occasionally be used to shrink down a large testicular cancer before surgery so that it can be removed more easily. This is known as neo-adjuvant chemotherapy.
Treatment for testicular cancer is very successful, and the cancer does not usually come back after standard chemotherapy.
High-dose chemotherapy may be used if standard chemotherapy does not completely get rid of the cancer cells (which is rare).
Chemotherapy drugs can cause unpleasant side effects, but these can usually be well controlled with medicines. Not all drugs cause the same side effects and some people may have very few side effects. Your doctor will tell you about any problems that your treatment may cause.
While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal white cells in your blood. When these cells are reduced, you are more likely to get an infection and you may tire easily. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infection.
If your temperature goes above 38°C (100.5°F), or you suddenly feel unwell, even with a normal temperature, you may have an infection. Contact your chemotherapy nurse or doctor at the hospital straight away.
Chemotherapy may reduce the number of red blood cells (haemoglobin) in your blood; a low level of red blood cells is known as anaemia. If you have anaemia, you will probably feel very tired and lethargic. You may also become breathless.
Anaemia can be very successfully treated with blood transfusions. This should help you to feel more energetic and ease the breathlessness.
Platelets are a type of blood cell which help to clot the blood. If the number of platelets in your blood is low you will bruise very easily and may bleed heavily from even minor cuts or grazes. If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately. We have separate information about platelet transfusions.
Some of the drugs used to treat testicular cancer can make you feel or be sick (nausea and vomiting), but there are very effective anti-sickness drugs (anti-emetics) to prevent this. It is helpful to avoid eating immediately before and after your chemotherapy. If the sickness is not controlled or continues, even with anti-sickness treatment, let your doctor know. They can prescribe other medicines that may be more effective.
Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during treatment, but many find they have to take things much more slowly. Tiredness can build up over a course of treatment, and if you have a lot of chemotherapy, it can last for several months or more after your treatment has finished. It is best to cope with tiredness by planning ahead. Try to fit in rest periods and don’t do things that you don’t need to do. Accept help from others when you need to. There may be times when you feel less tired. A little activity can sometimes help with the symptoms of fatigue.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. It is important to rinse your mouth regularly to keep it clean. Using a child’s soft toothbrush can be helpful. If you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.
Unfortunately, some chemotherapy drugs will make your hair fall out. People who lose their hair often cover up by wearing wigs, bandanas, hats or scarves. If you are being treated as an inpatient, or you are on income support, you can get a free wig from the NHS. If not, you can still get a subsidised wig from the hospital. Ask the team looking after you if a wig specialist is available to visit you. If your hair falls out it is important to protect your scalp from the sun. If you lose your hair it will start to grow back within three to six months of finishing your treatment.
The chemotherapy drug bleomycin can occasionally cause inflammation in the lungs and this can lead to breathlessness. This is usually mild, but if it becomes a problem your doctor may stop or change the drug. After having bleomycin you may not be able to take part in certain activities, such as sub-aqua diving. If you need to have an operation after having bleomycin, you should always tell the anaesthetist that you have had bleomycin treatment.
Another drug, cisplatin, can cause tinnitus (ringing in the ears) and you may lose the ability to hear some high-pitched sounds. This usually improves when treatment ends. Let your doctor know if you have any problems with your hearing. They may want to send you for a hearing test.
You may also notice numbness or tingling in your hands and feet or difficulty doing up buttons. Your hands and feet may also become more sensitive to the cold. This is due to the effect of the drug on the nerves and is known as peripheral neuropathy. Let your doctor know if this is a problem for you.
Chemotherapy can cause changes in the way that your kidneys work so you will have regular blood tests to see how well your kidneys are working.
Although they may be hard to deal with at the time, these side effects will gradually disappear once your treatment is over.
It is not advisable to father a child while having any of the chemotherapy drugs used to treat testicular cancer, as they may harm the developing foetus. It is important to use effective contraception during your treatment and for a year afterwards. You can discuss this with your doctor or specialist nurse.
Condoms should be used during sex within the first 48 hours after chemotherapy to protect your partner from any of the drug that may be present in semen.
Our section on chemotherapy discusses the treatment and its side effects in more detail.
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