Testicular Cancer

Further surgery

Usually, the only surgery that is needed is an orchidectomy (removal of a testicle) (see 'Orchidectomy'). However, further surgery is sometimes needed to remove cancer cells that have spread to other parts of the body. 

If not diagnosed in its early stages, testicular cancer may spread to the lymph glands. Two men needed a second operation in the groin area, quite soon after the initial orchidectomy, because doctors found that cancer cells had spread to nearby lymph nodes. One said that the cancer had spread up the spermatic cord.

Chemotherapy or radiotherapy is usually used to kill cancerous tumours in the abdomen, but sometimes doctors are not quite sure whether or not these treatments have been successful. In this case the surgeons may decide to remove the remains of a tumour to make sure there are no remaining cancer cells in what appears to be a non-cancerous lump.

Surgery to remove lymph glands in the abdomen may be quite a big operation. Some men were surprised when they heard that they would be in hospital for 8-10 days. One man recalled his recovery on the ward. He remembered his drips, his catheter, and a drain in the side of his stomach, and the morphine pump that was available for pain relief.

Another man had an operation to remove a tumour, which was lying beside the aorta (blood vessel) in his back. It was a major operation because it was hard to reach the tumour. He described the incision, which was held together with staples, and the fourteen-inch scar.

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Sometimes it is necessary to remove a rib so that surgeons can reach a tumour. Having had such a major operation, a man recalled his time in intensive care, linked up to heart monitors, breathing apparatus and pain management systems.

This operation can now be done using keyhole surgery, but this is still quite a new operation and needs an experienced surgeon to perform and therefore is not commonly done yet. It does have more side effects than the conventional surgery but the benefits are a shorter stay in hospital (about 4 days) and a quicker recovery time. Side effects can include injury to a blood vessel, damage to the bowel, bleeding, incomplete removal of the cancer, and a risk that the cancer could come back. Your doctor should explain the risks and uncertainties before you make a decision.
 
This is very complicated surgery and it should only be done by experienced surgeons.
  • NICE have decided that there is not enough evidence to recommend that keyhole surgery replaces open surgery for removing abdominal lymph nodes after testicular cancer because of safety concerns. It recommends that keyhole surgery should only be carried out:
  •  
•    if a person has been fully informed of the potential risks and uncertainties of this type of surgery beforehand
•    if the outcome of the surgery is carefully monitored by the hospital team afterwards
•    by a surgeon experienced in laparoscopic surgery (Macmillian Cancer Support 2012)
  •  
Rarely, a new tumour appears in another part of the body. One man developed a tumour in his neck two years after his initial treatment. The tumour, which was found by his doctor when he went for his regular follow up appointment, was successfully removed.

Occasionally, surgery is needed for other reasons. For example, one man had a laparoscopy to make sure he didn't have an undescended testicle. During a laparoscopy a scope is put into the abdomen so that the surgeons can see that everything looks normal.

Another man had a bronchoscopy, thoracoscopy and a mediastinoscopy to make sure that the tumours in his chest that were seen on X-Ray weren't cancerous. These are procedures that allow the doctor to look inside the lungs and chest. The thoracoscopy and mediastinoscopy involved an incision in the side of his chest, under anaesthetic. He found the investigations unpleasant, and needed a week in hospital.

 

Last reviewed March 2015.
Last updated March 2015.
 

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