Treatments for seminoma

The following are treatment options for the stages of seminoma testicular cancer. Treatment options can depend on the stage, the prognosis group (based on the International Germ Cell Cancer Consensus Group (IGCCCG) classification system) and the treatments that were used to treat the original cancer if it comes back (relapses). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the main treatment for stage 1 seminoma. The type of surgery done is called a radical inguinal orchiectomy (an orchiectomy). This surgery removes the testicle and spermatic cord through a small opening in the groin. It’s usually done as part of the diagnosis. Surgery, followed by active surveillance, is the only treatment that most men with stage 1 seminoma need.

Active surveillance is the preferred treatment option after surgery for stage 1 seminoma because there is a low risk that the cancer will come back. It involves regular and frequent follow-up to look for signs and symptoms that the cancer has come back. Tests done during a visit include a physical exam, blood tests to check tumour marker levels and imaging tests.

If the cancer comes back, it usually happens between 12 and 36 months after surgery. Treatment is given when you develop symptoms or the cancer changes.

Radiation therapy may be offered after surgery for stage 1 seminoma if you can't complete the regular and frequent follow-up of active surveillance. Radiation is directed at the lymph nodes in the back of the abdomen (called the retroperitoneum). It is sometimes given to the lymph nodes in the pelvis as well.

Chemotherapy may be offered after surgery for stage 1 seminoma if you can’t complete the regular and frequent follow-up of active surveillance. It can also be given after surgery if there are high levels of tumour markers in the blood. Most men are given carboplatin through a needle in a vein (intravenously).

Surgery is part of the treatment for stage 2 seminoma. The type of surgery done is called an orchiectomy.

Active surveillance is offered for stage 2A seminoma after surgery if tumour marker levels are not elevated in the blood.

Radiation therapy is offered after surgery for stages 2A and some 2B seminoma. Radiation is directed at the lymph nodes in the back of the abdomen and in the pelvis.

Chemotherapy is usually offered after surgery for stage 2 seminoma. Chemotherapy may also be used if any cancer comes back after radiation therapy. Chemotherapy is given through a needle in a vein (intravenously). You may be offered one of the following chemotherapy combinations:

• BEP – bleomycin, etoposide (Vepesid) and cisplatin
• EP – etoposide and cisplatin
• VIP – etoposide, ifosfamide (Ifex) and cisplatin

EP is used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage.

For stage 2C seminoma, the combination of chemotherapy drugs used depends on the tumour's prognosis, which is based on the IGCCCG classification system.

Men who have tumours in the good prognosis group are offered BEP or EP.

Men who have tumours in the intermediate prognosis group are offered BEP or VIP.

Surgery is part of the treatment for stage 3 seminoma. The first type of surgery done is an orchiectomy.

Chemotherapy is a standard treatment for stage 3 seminoma. It is usually given after an orchiectomy. Chemotherapy may also be used before surgery if the cancer had already spread and doctors confirmed it was seminoma by doing a biopsy of the metastases. Chemotherapy is given through a needle in a vein. You may be offered one of the following chemotherapy combinations:

• BEP – bleomycin, etoposide and cisplatin
• VIP – etoposide, ifosfamide and cisplatin
• EP – etoposide and cisplatin

EP and VIP are used when bleomycin affects the lungs or there is a high risk that it will cause lung damage.

The combination of chemotherapy drugs used depends on the tumour’s prognosis, which is based on the IGCCCG classification system.

Men who have tumours in the good prognosis group are offered BEP or EP.

Men who have tumours in the intermediate prognosis group are offered BEP or VIP.

After chemotherapy, the healthcare team will follow up with imaging tests to look for any cancer that remains (called residual disease) and signs that the cancer has come back.

If a residual lesion remains after surgery the doctors will watch the lesion for growth or changes. A PET scan or a biopsy or both may be done to assess the residual lesion. Surgery will only be offered if the lesion starts growing or if the PET scan results stay strongly positive for cancer over time.

Relapsed seminoma means that the cancer has come back after it has been treated. The following are treatment options for relapsed seminoma.

Chemotherapy is the main treatment for relapsed seminoma. The combination of chemotherapy drugs given will depend on the treatments that were used to treat the original cancer.

Men who were given radiation therapy after surgery to treat the cancer the first time will be offered BEP, EP or VIP for relapsed seminoma.

Men who were given BEP or EP the first time may be given another chemotherapy drug combination (called salvage chemotherapy) through a needle in a vein. You may be offered one of the following combinations:

• TIP – paclitaxel, ifosfamide and cisplatin
• VIP – etoposide, ifosfamide and cisplatin
• VeIP – vinblastine, ifosfamide and cisplatin

High-dose chemotherapy with carboplatin and etoposide may be used if testicular cancer comes back after it is treated with standard-dose chemotherapy or salvage chemotherapy. After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that are damaged or destroyed by high-dose chemotherapy. The stem cell transplant uses stem cells from your own blood (called autologous peripheral blood stem cell transplant).

Chemotherapy can also be used as palliative therapy if the cancer comes back after most other treatments. Palliative therapy is given to relieve symptoms rather than to treat the cancer itself. Palliative chemotherapy that may be used for seminoma includes:

• etoposide given by mouth (orally)
• gemcitabine with oxaliplatin or paclitaxel given through a needle in a vein

Surgery may be done to remove a seminoma if it comes back after salvage chemotherapy or high-dose chemotherapy with a stem cell transplant.

Radiation therapy can be used if the cancer comes back during active surveillance or after chemotherapy with carboplatin. The cancer must only be in the lymph nodes at the back of the abdomen. Radiation is directed at the retroperitoneal lymph nodes.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to men with testicular cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.