Testicular Cancer Treatment by Stage

Treatment of stage 0 may include the following:

• Radiation therapy.
• Surveillance.
• Surgery to remove the testicle. 

Treatment of stage I testicular cancer depends on whether the cancer is a seminoma or a nonseminoma.

Treatment of seminoma may include the following:

• Surgery to remove the testicle, followed by surveillance.
• For patients who want active treatment rather than surveillance, treatment may include:
  • Surgery to remove the testicle, followed by chemotherapy.

Treatment of nonseminoma may include the following:

• Surgery to remove the testicle, with long-term follow-up.
• Surgery to remove the testicle and lymph nodes in the abdomen, with long-term follow-up.
• Surgery followed by chemotherapy for patients at high risk of recurrence, with long-term follow-up. 

Treatment of stage II testicular cancer depends on whether the cancer is a seminoma or a nonseminoma.

Treatment of seminoma may include the following:

• When the tumor is 5 centimeters or smaller:
  • Surgery to remove the testicle, followed by radiation therapy to lymph nodes in the abdomen and pelvis.
  • Combination chemotherapy.
  • Surgery to remove the testicle and lymph nodes in the abdomen.
• When the tumor is larger than 5 centimeters:
  • Surgery to remove the testicle, followed by combination chemotherapy or radiation therapy to lymph nodes in the abdomen and pelvis, with long-term follow-up.

Treatment of nonseminoma may include the following:

• Surgery to remove the testicle and lymph nodes, with long-term follow-up.
• Surgery to remove the testicle and lymph nodes, followed by combination chemotherapy and long-term follow-up.
• Surgery to remove the testicle, followed by combination chemotherapy and a second surgery if cancer remains, with long-term follow-up.
• Combination chemotherapy before surgery to remove the testicle, for cancer that has spread and is thought to be life-threatening. 

Treatment of stage III testicular cancer depends on whether the cancer is a seminoma or a nonseminoma.

Treatment of seminoma may include the following:

• Surgery to remove the testicle, followed by combination chemotherapy. If there are tumors remaining after chemotherapy, treatment may be one of the following:
  • Surveillance with no treatment unless tumors grow.
  • Surveillance for tumors smaller than 3 centimeters and surgery to remove tumors larger than 3 centimeters.
  • A PET scan two months after chemotherapy and surgery to remove tumors that show up with cancer on the scan.
• A clinical trial of chemotherapy.

Treatment of nonseminoma may include the following:

• Surgery to remove the testicle, followed by combination chemotherapy.
• Combination chemotherapy followed by surgery to remove the testicle and all remaining tumors. Additional chemotherapy may be given if the tumor tissue removed contains cancer cells that are growing or if follow-up tests show that cancer is progressing.
• Combination chemotherapy before surgery to remove the testicle, for cancer that has spread and is thought to be life-threatening.
• A clinical trial of chemotherapy. 

Treatment of recurrent testicular cancer may include the following:

• Combination chemotherapy.
• High-dose chemotherapy and stem cell transplant.
• Surgery to remove cancer that has either:
  • come back more than 2 years after complete remission; or
  • come back in only one place and does not respond to chemotherapy.
• A clinical trial of a new therapy.