The first treatment for testicular cancer is usually surgery to remove the affected testicle. You might also need another surgery to remove lymph nodes from the back of your abdomen.
Learn about the different types of surgery and what to expect both during your hospital stay and after your operation.
Types of surgery for testicular cancer:
There are different types of surgery for testicular cancer:
– Orchidectomy: This is the surgery to remove the affected testicle. It’s done both to diagnose and to treat testicular cancer.
– Retroperitoneal Lymph Node Dissection (RPLND): If needed, your doctor may perform surgery to remove some lymph nodes from the back of your abdomen.
– Lung Surgery: If the cancer has spread to your lung, you might have surgery to remove the cancer from the lung.
Removing a testicle (orchidectomy):
Removing the testicle is known as an orchidectomy or orchiectomy. In rare cases, if the tumor is very small, the surgeon may only remove a part of the testicle, which is called a partial orchidectomy.
During the surgery, the surgeon makes an incision in the groin and cuts the spermatic cord to remove the testicle.
Removing lymph nodes (retroperitoneal lymph node dissection):
Lymph nodes are found in many parts of the body and can become enlarged if cancer spreads to them.
Testicular cancer can spread to the lymph nodes located in the back of the abdomen, called the retroperitoneal lymph nodes, which are in front of the spine.
If this happens, you might need surgery to remove these lymph nodes. This surgery, known as a retroperitoneal lymph node dissection, is a major operation and is usually done at a specialized centre.
Image lymph nodes (cruk)
Removing secondary cancer in the lungs:
Testicular cancer can spread to the lungs, which is known as secondary cancer. If this happens, you might need surgery to remove the cancer from your lungs.
Your doctor might recommend this surgery if:
– There are still signs of cancer after chemotherapy.
– The cancer seems resistant to chemotherapy.
What to Expect
This is major surgery performed under general anaesthesia, so you will be asleep during the operation.
After you wake up, you’ll have:
– A drip (intravenous line) in your vein
– Tubes coming out from your wound
– A chest drain (a tube in your chest connected to a suction bottle) to help your lung expand again
The surgery will cause the lung to collapse temporarily, and the chest drain helps it re-inflate. Sometimes, the surgery may involve cutting through ribs, which can be painful while healing.
You might need this surgery more than once if the tumors come back, depending on your overall health and treatment preferences.
Removing lymph nodes for testicular cancer (retroperitoneal lymph node dissection):
You might need surgery to remove lymph nodes from your abdomen, known as the retroperitoneal lymph nodes. This surgery is called a retroperitoneal lymph node dissection.
It’s a major operation, and you may need to stay in the hospital for up to 5 days, depending on how the surgery goes.
What are retroperitoneal lymph nodes?:
Lymph nodes are a network of glands found throughout your body. Cancer can spread to these nodes and cause them to become enlarged.
Testicular cancer can spread to the lymph nodes in the back of your abdomen, known as the retroperitoneal lymph nodes, which are located in front of your spine.
Image of lymph nodes(cruk)
When do you have it:
Your doctor will discuss with you whether you need this surgery based on factors like the type and stage of your testicular cancer.
You might have this surgery if:
– Scans show your lymph nodes are still enlarged after chemotherapy.
– For stage 2A non-seminoma cancer, if chemotherapy isn’t an option and your tumor markers are normal.
– You cannot have chemotherapy or regular monitoring for some reason.
What happens:
This surgery is quite extensive and is done at a specialized centre. You might have a team of different surgeons, including a urologist and a vascular surgeon.
You will be under general anaesthesia, and the surgery can last between 3 and 7 hours.
Open Surgery:
– If you’re having this surgery after chemotherapy, it’s usually done as open surgery.
– The surgeon makes a long cut in your abdomen, from just below your rib cage to below your belly button.
Keyhole Surgery:
– If you haven’t had chemotherapy, you might have keyhole surgery, though it’s less common and usually done at specialized hospitals.
– Also known as laparoscopic surgery, this method involves several small cuts in your abdomen, with the help of a robotic system, rather than one large cut.
Problems after surgery:
This surgery can sometimes damage nerves that control ejaculation, which might lead to:
– Difficulty ejaculating
– Sperm going into your bladder (retrograde ejaculation)
Even if this happens, you should still be able to get an erection and have an orgasm. However, with retrograde ejaculation, you won’t be able to father a child through sexual intercourse. Your doctor will discuss sperm banking with you before the surgery.
There’s a specialized technique called nerve-sparing lymph node dissection that aims to avoid this issue. This is a highly specialized procedure and might require traveling to a specialist hospital. It’s not always possible if the cancer is near the nerves, as leaving them could increase the risk of the cancer returning.