Testicular Cancer: Chemotherapy

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines travel all over your body in your blood. They attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

Not everyone with testicular cancer needs chemo. Whether you need chemo and what type you need depends on:

• The type of testicular cancer you have

• The extent (stage) of the cancer

• Your age and overall health

• Concerns you have about side effects

• What treatments you have had in the past

Your healthcare provider may suggest chemo if:

• There's concern that the cancer might have spread outside the testicle. In this case, chemo might be used after surgery to kill any remaining cancer cells.

• You have cancer that has clearly spread outside the testicle. Chemo often works well to kill testicular cancer cells, even if they have spread to other parts of the body.

• The cancer has come back after your first treatment. Your healthcare provider might advise another course of standard chemo. Or high-dose chemo followed by a stem cell transplant might be advised.

Before treatment starts, you will meet with a medical oncologist. This is a healthcare provider who treats cancer with medicines. They will discuss your treatment choices and talk with you about what you might expect.

Chemotherapy for testicular cancer is given right into your blood through an IV. This means the medicine is given through a small tube that's put into a vein. It usually drips in slowly over several hours.

You usually get chemo as an outpatient at a hospital, clinic, or your healthcare provider's office. You go home after treatment. Less often, you may need to stay in the hospital during treatment. You'll be watched for reactions during your treatments. Each treatment may last a few hours. You may want to take along music to listen to or something else that is comforting to you. You may also want to bring something to keep you busy, such as a book or mobile device.

You get chemotherapy in cycles over a period of time. That means you get the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Your healthcare provider will discuss your chemo schedule with you.

Having treatment in cycles helps by:

• Killing more cancer cells. The medicine can kill more cancer cells over time, because cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.
• Giving your body a rest. Treatment is hard on other cells that divide quickly. This includes cells in the lining of your mouth and stomach. This causes side effects, such as mouth sores and upset stomach. Between cycles, your body can heal and get a rest from the chemo.
• Giving your mind a rest. Getting chemo can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

Common medicines to treat testicular cancer include:

• Bleomycin

• Cisplatin

• Etoposide

• Ifosfamide

• Paclitaxel

• Vinblastine

In most cases, two or three of these medicines are used at the same time.

Side effects of chemo are different for everyone. Possible side effects depend on which medicines are used and the dose. Ask your healthcare team for details about the side effects you should watch for and how to prevent or manage them.

These are some of the most common side effects of chemo:

• Hair loss. If you have hair loss, it will grow back after treatment stops.

• Infection. During your treatments, you may have low white blood cell counts. This means your immune system won’t be working as well as it normally does. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of infection.

• Nausea and vomiting. These can often be controlled with medicines.

• Diarrhea. This can be controlled with medicines. You may also need to make changes in your diet.

• Mouth sores. These may make it hard for you to eat or swallow. The best way to help prevent this problem is to keep your mouth very clean. And don't eat foods that could irritate your mouth.

• Bleeding and bruising more easily. This can happen if chemo lowers your blood platelet counts. Platelets are needed to help the blood clot.

• Fatigue. It's very common to feel tired while getting chemo. This often gets better over time after treatment. 

Some side effects happen more often with certain medicines. For instance:

• Cisplatin and ifosfamide can cause kidney damage. 

• Cisplatin, vinblastine, paclitaxel, and etoposide can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. 

• Bleomycin can damage your lungs.

• Cisplatin can cause hearing problems.

• Ifosfamide can cause bleeding in the bladder.

Many chemo side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends. But some may last a long time or not go away completely. Ask your healthcare team what you can expect.

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. Make sure you know what number to call with questions. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.