Chemotherapy for Testicular Cancer


Chemotherapy is a term used for certain medications or drugs which are specifically formulated to kill cancer cells through a variety of different mechanisms. There are many different types of chemotherapeutic agents and each one is unique in how it works, what cancer(s) it fights, how it is given and what side-effects may occur. Chemotherapies are derived from a variety of sources, both synthetic and naturally occurring, such as those derived from Vinca plants.

 They can be given through various different routes including intravenously (IV), by mouth and may be given directly into certain areas of the body including the central nervous system and the abdomen. is an excellent online resource to look at many different chemotherapies and chemotherapy regimens.


 Surgery is almost always the first step in treating testicular cancer. Chemotherapy is used after surgery for testicular cancer in two main groups: Those receiving after it after surgery to prevent the cancer from coming back (this is known as adjuvant chemotherapy) and those who receive if the cancer has already spread (i.e. metastasized). Chemotherapy may still be used months to years after surgery if the cancer has been found to metastasize at a later time.

The decision to administer chemotherapy as part of treatment is complex and largely based on the testicular cancer type and stage.

 When the cancer has spread beyond the primary tumor (i.e., the testis) and regional lymph nodes, chemotherapy needs to be given if cure is to be obtained. If it has spread to the regional lymph nodes, but nowhere else, something more still needs to be done. This could consist of chemotherapy, surgical lymph node removal or radiation.

 If the cancer appears to be limited to the testis, chemotherapy and other treatments are optional, but may still be recommended to prevent the cancer from coming back. With such an important decision, it is imperative that an experienced oncology team be involved in the decision-making process.


Chemotherapy is not just simply chemotherapy. There are hundreds of chemotherapeutic agents which have been produced since its development last century. They kill cancer cells in a variety of ways and different cancers are sensitive to certain chemotherapies and resistant to others. A good comparison is antibiotics. Certain antibiotics will kill one type of bacteria but not another. The chemotherapies that make up the backbone of first-line treatment for testicular cancer are carboplatin, cisplatin, etoposide, bleomycin and ifosfamide.


Again, depending on the exact testicular cancer type  and stage will determine which chemotherapy or chemotherapies are used, if used at all.


All of these chemotherapies are given intravenously (IV). IV access can be obtained peripherally with a smaller, short-term catheter, which is typically placed in the arm. Longer-term IV access can be accomplished with a central catheter which ranges from a longer catheter inserted in the arm, chest or neck or an implanted device oftentimes known as a Port-O-Cath. The chemotherapy is mixed in an IV bag of fluid and drips into the vein at a set rate.

Chemotherapy is organized into a certain number of days known as a cycle. Some chemotherapies are given just one day in a cycle, others are given multiple days. Some chemotherapies have just one cycle, others have many. The most simple regimen is simply one single dose of carboplatin for an early stage testicular cancer. Other regimens administering chemotherapy the first 5 days of a 21 day cycle for up to 4 cycles. Those receiving it for metastatic cancer typically receive 4 cycles regardless of the exact regimen.


Bone marrow suppression can be caused by any of the agents, especially cisplatin, and carboplatin. The bone marrow is where all the blood products are produced, namely, the red blood cells that carry oxygen, the white blood cells that fight infection and the platelets which are essential in clot formation. As a result, infections and bleeding problems may result.

Nausea and vomiting are not uncommon, with cisplatin having the greatest potential for such effects. Anti-nausea medications are typically given before and provided for use afterward to limit nausea.

Both cisplatin and carboplatin can be toxic to the kidneys and result in renal failure. To reduce this risk, it is important to receive IV hydration the day of chemotherapy and to be well hydrated before and after the treatment. 

Hypersensitivity reactions, i.e. allergic reactions, are another possible complication. These are greatest in carboplatin and cisplatin. The most serious reaction is anaphylaxis which can impair breathing by airway swelling. 

Bleomycin is unique from the other chemotherapies in that it can be cause serious lung problems. It can cause an inflammatory process in the lungs known as pneumonitis which can result in scarring known as pulmonary fibrosis. This may be a permanent condition affecting breathing capacity. Pulmonary function tests may be performed as a baseline and with any evidence of potential lung compromise.

Hair loss (alopecia) is not nearly as common as some other types of chemotherapies. Ifosfamide has the greatest potential for hair loss, followed by etoposide. Carboplatin, cisplatin, and bleomycin typically do not cause any hair loss of significance.

Other side effects may include electrolyte imbalances, nerve pain in the hands and/or feet, diarrhea, low blood pressure, rashes and other skin changes. Some effects are transient and resolve with time while others may be chronic. As with anything in medicine, the benefit is weighed against the potential risks. It is seldom known beforehand what side effects each individual may encounter.


An important consideration prior to initiating chemotherapy is whether sperm banking is to be pursued. Several treatments for testicular cancer, especially chemotherapy, can potentially result in infertility. This should be part of the discussion with the oncologist prior to initiating treatment. More information on fertility and sperm banking can be found here.

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