Testicular cancer is a highly curable malignancy, but its treatment is complex and necessitates the coordinated effort of a specialized, multidisciplinary medical team. The patient’s journey involves highly trained physicians, each contributing expertise to the diagnosis, treatment, and long-term monitoring phases. This team approach ensures that patients receive precise, personalized care tailored to the specific type and stage of the disease.
Initial Diagnosis and Surgical Intervention
The initial management of testicular cancer is typically led by a specialized surgeon, often a Urologist or a Urologic Oncologist. This physician is responsible for confirming the diagnosis and performing the primary surgical procedure, which is the standard first step. The definitive diagnostic and therapeutic procedure is the radical inguinal orchiectomy, which involves removing the affected testicle and the spermatic cord through an incision in the groin area.
Unlike many other cancers, a biopsy is rarely performed before this surgery, as it risks spreading cancer cells to the scrotum. Tissue from the removed testicle is immediately sent for analysis to determine the cancer type, distinguishing between seminoma and non-seminoma, which informs subsequent treatment decisions. In certain cases, the urologic oncologist may also be involved in performing a Retroperitoneal Lymph Node Dissection (RPLND).
This is a complex procedure to remove lymph nodes deep in the abdomen, near the major blood vessels (the aorta and vena cava), where testicular cancer cells often spread first. The RPLND can be performed either as a staging tool for early-stage disease or to remove residual masses after chemotherapy. Due to the technical difficulty and the need to preserve surrounding nerves, this surgery is often performed only at high-volume cancer centers by surgeons with specific expertise.
Systemic Treatment and Chemotherapy Management
Following the surgical removal of the primary tumor, the patient’s care transitions to the Medical Oncologist, the specialist in systemic treatments. This physician uses the information from the orchiectomy—the cancer type and pathological stage—to determine the overall treatment strategy. Depending on the risk of recurrence, the plan may involve active surveillance or active treatment.
If the cancer has spread beyond the testicle, or if the risk of recurrence is high, chemotherapy is the standard treatment. The Medical Oncologist designs and administers specific chemotherapy regimens, most commonly using combinations of drugs containing Cisplatin. Common protocols include BEP (Bleomycin, Etoposide, and Cisplatin) or EP, which omits the Bleomycin.
The oncologist closely monitors serum tumor markers, which are proteins in the blood that can indicate the presence of cancer, such as Alpha-fetoprotein (AFP), Human Chorionic Gonadotropin (HCG), and Lactate Dehydrogenase (LDH). These markers are tracked before, during, and after treatment to assess the tumor burden and measure the effectiveness of the chemotherapy. Managing the toxicities and side effects associated with these powerful drugs is a continuous responsibility of the Medical Oncologist.
Supporting Specialists and Survivorship
The treatment plan is ultimately guided by the Pathologist, who analyzes the tissue removed during the orchiectomy. The pathologist’s detailed report confirms the diagnosis, identifies the exact cell type—seminoma or non-seminoma—and assesses for features like lymphovascular invasion. This analysis provides the foundation for the Medical Oncologist’s systemic treatment decisions.
Another specialist who may become involved is the Radiation Oncologist, particularly for patients with certain stages of pure seminoma. While radiation therapy is less common for testicular cancer, it may be used to treat cancer that has spread to the lymph nodes in the abdomen. This physician uses precise, high-energy beams to destroy cancer cells in a targeted area.
Once active treatment is complete, the focus shifts to long-term care, often managed through dedicated survivorship clinics. These clinics involve a range of supporting professionals, including Advanced Practice Providers and Primary Care Physicians, to monitor for late effects of treatment. Endocrinologists may be consulted to manage potential hormone changes, while mental health professionals provide necessary support to address the psychological impact.