When and how you may have chemotherapy for testicular cancer, and the side effects this can have.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate around your body in the bloodstream. They work by disrupting the growth of cancer cells.
When you have chemotherapy
You might have chemotherapy to:
- help prevent the cancer coming back after you've had a testicle removed (called adjuvant chemotherapy)
- treat cancer that has come back after initial treatment
- treat cancer that has spread outside the testicle
Testicular cancer cells can spread to the lymph glands that run alongside the major blood vessel in the tummy (abdomen) – the aorta. These are called the para aortic lymph glands.
The cancer can also spread to the lungs. More rarely it can spread to organs such as the brain and liver.
How you have chemotherapy
You usually have treatment with a combination of chemotherapy drugs. You have the drugs into your bloodstream by injection or through a drip (intravenously).
You usually have the drugs over a few days at a cancer day clinic. Then you rest for a couple of weeks before repeating the treatment.
Each round of treatment is called a cycle. The number of cycles you have depends on:
- whether your cancer has spread
- how well your cancer responds to the drugs
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
After surgery (adjuvant chemotherapy)
You might have chemotherapy after surgery to remove a testicle. This treatment lowers the chance of early stage cancer coming back. It is called adjuvant chemotherapy.
For early stage seminoma you usually have 1 treatment with the drug carboplatin (Paraplatin).
For early stage non seminoma you usually have 2 cycles with a combination of chemotherapy drugs called BEP or PEB. BEP contains the drugs bleomycin, etoposide and cisplatin.
If cancer has spread or come back
You might have chemotherapy with the BEP drug combination if your cancer has spread or comes back during monitoring (surveillance)
You have 3 or 4 treatment cycles. Your doctor might use blood tests to check how well the treatment is working.
Or you might have treatment with:
- PEI (cisplatin, etoposide, ifosfamide) – this drug combination is also called VIP
- TIP (paclitaxel (Taxol), ifosfamide, cisplatin)
- VeIP (vinblastine, ifosfamide, cisplatin)
- POMB/ACE (cisplatin, vincristine, methotrexate, bleomycin, actinomycin, cyclophosphamide and etoposide)
These treatments can make you infertile. So your doctor usually offers you the chance to bank sperm before you start the chemotherapy.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for the few days that you’re having the chemotherapy drugs. Your treatment team can help to reduce your side effects.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you take any supplements or if you’re prescribed them by alternative or complementary therapy practitioners.
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
When you go home
Chemotherapy for testicular cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.