This page discusses the use of surgical procedures for the treatment of testicular cancer. For a thorough review of surgical procedures for cancer treatment, please see the surgery treatment monograph .

Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.

There are two surgical procedures done to treat testicular cancer: orchiectomy and retroperitoneal lymph node dissection (RPLND).

Orchiectomy

Orchiectomy is the surgical removal of the testicle. If your symptoms and the results of your ultrasound strongly suggest cancer, an orchiectomy is usually done in order to confirm the diagnosis and as an important first step in treatment. A biopsy of the testicle is almost never done since a solid mass in the testicle almost always proves to be cancerous.

Description of the Procedure

This procedure is usually done under general or spinal anesthesia.

The surgeon will make an incision in your groin very similar to a hernia repair. From this approach, the contents of the scrotum on that side can be removed entirely without cutting into the scrotum and risking spread of the cancer into the scrotal tissues. The incision will heal with a minimum of complications because the entire procedure is relatively superficial, not entering deeply into any major body cavity.

It is possible during this procedure or in a subsequent operation to place a prosthetic (fake) testicle in the scrotum to recreate a normal appearance.

Effectiveness

If the cancer is confined to the testicle, this procedure by itself is curative. If there is spread to other parts of the body, then additional treatment ( chemotherapy or radiation therapy ) is needed.

Possible Complications

All surgery runs the risk of infection, bleeding, and unexpected reactions to medications and anesthetic agents. Beyond that, this particular surgery occasionally injures a sensory nerve in the area, resulting in localized pain or numbness.

Postoperative Care

Many orchiectomies can be done as outpatient procedures, although you may have to spend a night or two in the hospital to manage or watch for complications.

Retroperitoneal Lymph Node Dissection (RPLND)

If a non-seminoma cancer may have spread beyond the testis but is likely to be confined to the lymph nodes in the retroperitoneum (area in the back of the abdomen), you may have these lymph nodes surgically removed. This procedure is called a retroperitoneal lymph node dissection (RPLND).

Description of the Procedure

An incision is made along your abdomen and every lymph node from the diaphragm to the anus is inspected. Any that may have cancer are removed and sent to the lab for analysis. This is major surgery; it usually takes four to six hours, but it can take longer.

Effectiveness

This procedure is remarkably effective. It usually results in cure. If there is the possibility that any cancer remains, it is treated with adjuvant (additional or supplementary) chemotherapy .

Possible Complications

All surgery runs the risk of infection, bleeding, and unexpected reactions to medications and anesthetic agents. Because this surgery is extensive, these risks are somewhat greater than for the average abdominal procedure.

Historically, this procedure could cause significant side effects including retrograde ejaculation (ejaculation of semen back into the bladder). More recent advances in surgical techniques, however, have made these side effects much less common.

Postoperative Care

You may spend up to a week in the hospital after this extensive surgery. You will need pain medication; your bowels will be slow to get going again; and the surgical team will want to watch you closely for complications.

After you go home, an inspection of the tissue removed from your abdomen will determine if you should have additional treatment, probably chemotherapy . For advanced non-seminomas, you may already have had a course of chemotherapy.