Surgical Procedures: Surgery and Staging for Testicular Cancer

Cancerous cells in one or both of the testicles is called testicular cancer. The testes are found in the scrotum and their job is to make sperm and testosterone.

What is staging and how is it performed?

Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For testicular cancer, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues.

Serum Markers: These are blood tests to look for tumor markers, which include Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (β-hCG) and Lactate dehydrogenase (LDH). These blood tests will be done before a testicle is removed and before biopsy.

Imaging: These are radiology tests that can look inside your body to see the cancer and if it has spread. These tests can include: 

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Testicular cancer spreads to other parts of the body through the tissue, lymph, and blood systems. Cancer is given a stage based on how much cancer there is and how far it has spread. This is then used to figure out the best treatment for you.

Surgical Procedures Used for the Treatment of Testicular Cancer

Surgery is often used to treat testicular cancer. The type used will depend on many factors, such as the size and where the cancer is. Your surgeon will talk to you about your procedure. 

Surgical procedures used to treat testicular cancers include:

• Radical Inguinal Orchiectomy: The testicle is removed through an incision (cut) made in the groin. A prosthetic saline-filled testicular implant can be placed where the testicle used to be.
• Retroperitoneal Lymph Node Dissection: An incision (cut) is made in the abdomen (belly) and lymph nodes are removed.
• Laparoscopic Surgery: At times, lymph nodes can be removed laparoscopically (a less invasive type of surgery), through small incisions (cuts) in the abdomen. A surgeon will use a laparoscope (thin tube) with a light, camera, and other surgical tools. The benefits of a laparoscopic procedure are faster recovery and less pain.

What are the risks associated with testicular surgery?

Risks can include:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through surgery, not remember it, and manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure.)
• Blood clots.
• Infection.
• Bleeding.
• Bowel obstruction.
• Nerve damage.
• Ejaculation issues.
• Erectile dysfunction (not being able to get/sustain an erection).
• Low sex drive.
• Infertility (not being able to father a child). 
• Pain.
• Hot flashes.
• Loss of muscle mass.
• Change in self-image.

What is recovery like?

Recovery from testicular surgery may include a stay in the hospital for one to ten days, based on the extent of the procedure. You may have a temporary urinary catheter to drain urine from your bladder. This is often taken out in 2-4 days. You will be told how to care for your incision before leaving the hospital.

Your medical team will discuss with you the medications you will be taking for blood clot, constipation, and infection prevention, as well as pain and nausea management.

After an orchiectomy you may need to:

• Wear a scrotal support and use ice packs as directed.
• Take pain medication as prescribed. 
• Avoid straining with bowel movements and try to prevent constipation (through diet/lifestyle and medication).
• Use a donut cushion while sitting if pain is a problem.
• Not lift anything heavy, play any sports, run, or jog until you are told that you can by your provider.
• Talk to your provider about when you can drive and return to work.

After a retroperitoneal lymph node dissection, you may need to:

• Take pain medication as prescribed.
• Not lift anything heavy or drive until you are told that you can by your provider.
• Shower as advised.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.