About testicular cancer chemotherapy

Chemotherapy uses anti cancer or 'cytotoxic' drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.

You may be given chemotherapy to

• Help prevent the cancer coming back after surgery
• Treat any cancer that has spread

Testicular cancer cells can spread to the lymph glands that run up the major blood vessel - the aorta. These are sometimes called the para aortic lymph glands. If your doctor suspects this may have happened in your case, you may be asked to have chemotherapy.

Chemotherapy is more often used for non seminoma testicular cancers. But it is also used to treat seminomas that have spread. And it may be offered as an alternative to radiotherapy for people with stage 1 seminoma.

You will usually have treatment with several different drugs. They are normally given intravenously, that is, by injection into a vein, or through a drip. Usually for testicular cancer, you need at least one of the drugs through a drip. So this means spending some time in hospital. The drugs are usually given over a few days. Then you rest for a couple of weeks before the treatment is repeated. 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

For early testicular cancer, you may have only one or two cycles to help stop the cancer from coming back (recurrence). But if your cancer has already spread, you may need 3 or 4 cycles. Even more cycles may be given for a very advanced testicular cancer. If you have raised markers in your blood, your treatment can be monitored with blood tests. When the chemotherapy works, the level of the markers in your blood will go down.

Testicular cancer can be treated with different combinations of drugs. But the combination most often used is BEP. This stands for

• Bleomycin
• Etoposide
• Cisplatin

You can have BEP as an outpatient. Each cycle of treatment is usually given over 3 days. Some people are allergic to bleomycin. If this is the case, you may be given a drug called ifosfamide instead.

If you have Stage 1 seminoma you might have treatment with just one dose of a chemotherapy drug called carboplatin.

There is information about the general side effects of chemotherapy in the main chemotherapy section of CancerHelp UK. And about the specific side effects of BEP in this section.

Your specialist may think you need more intensive treatment with chemotherapy. This could be because your testicular cancer

• Did not go into remission with previous chemotherapy
• Has come back after earlier treatment
• Is in the 'poor prognosis' category

There are different combinations of chemotherapy that can be used. Treatment in these circumstances is decided by your specialist on an individual basis. These combinations should be given in a specialist cancer centre. You may have

• VeIP - vinblastine, ifosfamide and cisplatin
• TIP - taxol, ifosfamide and cisplatin
• POMB/ACE - cisplatin, vincristine, methotrexate, bleomycin, dactinomycin, cyclophosphamide and etoposide
• High dose treatment with carboplatin and etoposide

Click on the links for information on the side effects of these drugs.

You may be offered high dose treatment with carboplatin and etoposide. 'High dose' treatment means that such high doses of chemotherapy are used that your bone marrow cells are damaged. To correct this, you are given your own blood stem cells back through a drip after your chemotherapy. Your blood stem cells are collected by machine before you are given the chemotherapy and kept frozen in storage until you need them. This type of treatment is sometimes called 'stem cell rescue' or 'stem cell transplant'. Strictly speaking, it isn't a transplant as your own cells are given back to you. This is a tried and tested technique for treating several different types of cancer these days. It is harder to get through than regular chemotherapy, but remember, even testicular cancers that have proved hard to treat can be cured. There is more about high dose treatment in the about cancer treatment section of CancerHelp UK.

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

Look at the main chemotherapy section in CancerHelp UK. It explains the treatment in more detail including

• What chemotherapy treatment involves
• How your doctor plans your chemotherapy and gives your treatment
• General side effects
• Side effects of particular chemotherapy drugs
• Living with chemotherapy

If you would like more information about anything to do with chemotherapy, contact one of the organisations on our testicular cancer information organisations page. They will be happy to help. They often have free factsheets and booklets that they can send to you.

You can also contact our cancer information nurses. They would be happy to help.