Chemotherapy for testicular cancer

What is chemotherapy?

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

The drugs most commonly used to treat testicular cancer are:

bleomycin
etoposide
cisplatin.

This combination is called BEP chemotherapy. Some men have a drug called carboplatin.

You may have other combinations of chemotherapy drugs. This will depend on the stage and type of testicular cancer, or if it has come back after treatment.

You may have chemotherapy:

after surgery, to reduce the risk of testicular cancer coming back (adjuvant chemotherapy)
to treat testicular cancer that has spread outside the testicle, or come back after an orchidectomy
to treat testicular cancer that has come back after initial chemotherapy.

Adjuvant chemotherapy

You may have adjuvant chemotherapy to reduce the risk of testicular cancer coming back.

Non-seminoma early (stage 1) - you may have 1 to 2 cycles of BEP. Each cycle is three weeks.
Seminoma, early (stage 1) - you may have a single treatment with carboplatin.

If testicular cancer has spread or comes back during surveillance

You may have 3 or 4 cycles of BEP if testicular cancer has:

spread outside the testicle
comes back during surveillance.

Sometimes, bleomycin is left out and you have 4 cycles of etoposide and cisplatin (EP) instead.

Bleomycin may cause breathing problems if you smoke, or already have a lung condition (see below).

Intensive chemotherapy

If BEP does not get rid of the cancer completely, or the cancer comes back again, you usually have more intensive chemotherapy.

Depending on the stage of the cancer, some men have more intensive chemotherapy straight away.

Some drug combinations are:

PEI (cisplatin, etoposide, ifosfamide) – this drug combination is also sometimes called VIP
TIP (paclitaxel, ifosfamide, cisplatin)
VeIP (vinblastine, ifosfamide, cisplatin).

High-dose chemotherapy with stem cell support (autologous stem cell transplant)

Occasionally, high-dose chemotherapy with stem cell support may be given. Stem cells produce blood cells.

The treatment destroys stem cells in the bone marrow, as well as destroying the cancer cells. Because of this, some of your stem cells are taken and stored before you have high-dose treatment. After the treatment, your stored stem cells are given back to you through a drip (infusion). This is called an autologous stem cell transplant.

High-dose chemotherapy with stem cell support allows you to have higher than usual doses of chemotherapy to treat testicular cancer. You usually have it if the cancer has not responded completely to treatment. Or you may have it if the cancer has come back after treatment. It is used to increase the chances of curing the cancer

How chemotherapy is given

You usually have chemotherapy drugs as an outpatient. A nurse gives you the drugs into a vein (intravenously) as an injection or a drip. They may be given through:

a thin, flexible tube inserted into a vein in the back of your hand (cannula)
a plastic line called a central line, which is put into a vein in your chest
a thin tube inserted into a vein in your arm, near the bend of your elbow (PICC line).

Chemotherapy is given in cycles of treatment. A cycle usually takes 3 weeks.

If you are having BEP, you usually spend 3 to 5 days going to hospital as an outpatient. Sometimes you will stay overnight. This is followed by weekly outpatient visits to have the rest of your treatment.

Other combinations of chemotherapy drugs might mean you spend more time in hospital and have the drugs more often. Your doctor or nurse will tell you how many cycles of treatment you will have.

Side effects of chemotherapy for testicular cancer

Chemotherapy drugs causes side effects. But there are usually ways these can be controlled. The side effects can depend on the type of chemotherapy drugs used. Your doctor or nurse will give you information about the likely side effects of your treatment.

We have more information about the side effects of chemotherapy.

Chemotherapy for testicular cancer often causes infertility during treatment and for a time after. This is usually temporary, and fertility usually recovers after treatment. But your doctor will advise you to consider storing sperm.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our chemotherapy forum to talk with people who have had chemotherapy, share your experience, and ask an expert your questions.

Sex and protecting your partner

If you have sex in the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen.

Cancer cannot be passed on to your partner and sex will not make the cancer worse.

Fertility

Chemotherapy for testicular cancer often causes infertility during treatment and for a time after. This is usually temporary, and you should recover your fertility after treatment. But your doctor will advise you to consider storing sperm before having treatment. How quickly your sperm count recovers varies from person to person. It generally starts to recover after about 18 to 24 months following treatment. But it can take up to 5 years to recover.

You may have a low sperm count before you start cancer treatment. Treatment with chemotherapy can sometimes improve sperm production, once the sperm count has recovered after treatment.

If you are having high-dose chemotherapy have a much risk of infertility and infertility is often permanent. If you are concerned about this, you can talk to specialist.

Preventing pregnancy

Although treatment may affect your fertility, it is not always possible to know when this will happen. You may still be able to get someone pregnant. Your doctor will advise you not to start a pregnancy during treatment. This is because the chemotherapy drugs can temporarily damage your sperm, and possibly harm a developing baby.

It is usually best to use a ‘barrier’ method of contraception, such as a condom, while you are having treatment.

It is also important to continue using effective contraception for about a year after chemotherapy. This allows time for your sperm to recover from any damage that treatment may have caused. You can talk to your cancer doctor or nurse about this.

About our information

References

Below is a sample of the sources used in our testicular cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Association of Urology. Guidelines on Cancer. 2016. Available from: www.baus.org.uk/_userfiles/pages/files/professionals/sections/oncology/EAU2015-Testicular-Cancer.pdf (accessed August 2018)

European Society for Medical Oncology, eUpdate. Testicular Seminoma and Non-Seminoma Treatment Recommendations. June 2017. Available from: www.esmo.org/Guidelines/Genitourinary-Cancers/Testicular-Seminoma-and-Non-Seminoma/eUpdate-Treatment-Recommendation (accessed August 2018).

Scottish Intercollegiate Guidelines Network, Management of adult testicular germ cell tumours. Available from: www.sign.ac.uk/sign-124-management-of-adult-testicular-germ-cell-tumours.html (accessed August 2018).

UpToDate. Clinical manifestations, diagnosis, and staging of testicular germ cell tumors. January 2018. Available from: www.uptodate.com/contents/clinical-manifestations-diagnosis-and-staging-of-testicular-germ-cell-tumors (accessed August 2018).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Jim Barber, Consultant Clinical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Content under review

Due to the pandemic, there have been delays in us updating this information as quickly as we would have wanted. Our team is working hard to put this right.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

You can read more about how we produce our information here.