Chemotherapy for Testicular Cancer - An Overview

Introduction

Drugs that are used to treat cancer are known as chemotherapy, and drugs can be used in the form of pills or injected by the needle into a vein or a muscle. The drugs are usually injected into the vein to treat testicular cancer. Chemotherapy is a systemic therapy where there is destruction of cancer cells that break off from the primary tumor and travel to lymph nodes or other parts of the body. With the help of chemotherapy, the testicular cancer that has spread outside the testicle is usually cured. After the testicle is removed, it decreases the risk of cancer coming back. It is used not only to treat cancer in the testicle.

What Is Chemotherapy?

Chemotherapy destroys cancer cells with anticancer drugs, which circulate in the bloodstream. It might be given when there is a higher risk of cancer coming back. Combinations of chemotherapy drugs are usually given. The drugs are injected or given intravenously through a drip.

When Is Chemotherapy Indicated?

Chemotherapy is indicated in cases such as:

• To prevent the cancer from coming back after the individual has undergone surgery to remove a testicle.

• To treat cancer that has come back after the initial treatment.

• To treat cancer that has spread outside the testicle.

To reduce the risk of testicular cancer coming back, adjuvant therapy is given.

• If the individual has an early stage1 non-seminoma, the individual can have one cycle of Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy. Each cycle is three weeks.

• If the individual has an early stage1 seminoma, the individual can have a single treatment with carboplatin.

What Is Testicular Cancer?

Testicular cancer will develop when cancer cells are present in the tissues of one or both testicles. Testicles produce sperm and the hormone testosterone. Testicular cancer is a serious condition that is highly treatable and curable.

What Are the Types of Testicular Cancer?

Almost all testicular cancer arises from germ cells in the testicles, which clump together to form a mass of tumors. Germ cells eventually develop into sperm. There are two types of testicular cancer that arise from germ cells.

• Seminoma: They are slow-growing cancers that primarily affect people in their 40s or 50s.

• Non-Seminoma: These cancers grow more rapidly than seminomas. It mainly affects individuals in their teens, 20s, and early 30s. There are four types of non-seminoma tumors such as embryological carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.

What Are the Chemo Drugs Used to Treat Testicular Cancer?

In cycles, chemo is given with each period of treatment, followed by a rest period so that the body has time to recover. The cycles of chemo usually last about three to four weeks. The drugs commonly used to treat cancer are Bleomycin, Etoposide, and Cisplatin, and this combination is known as BEP chemotherapy.

Testicular cancer can be treated by particular drugs such as:

• Etoposide.

• Cisplatin.

• Bleomycin.

• Ifosfamide.

• Paclitaxel.

• Vinblastine.

Rather than using only a single drug, when two or more chemotherapy drugs are used, it often works better.

What Is Combination Chemotherapy?

Combination treatment therapy has two treatment regimens: BEP (Bleomycin, Etoposide, and Cisplatin) and VIP (Etoposide, Ifosfamide, and Cisplatin). The particular regimen is given depending on the individual patient's features, especially the status of the lungs. This therapy is very effective in treating testicular cancer patients.

How Is Chemotherapy Given?

Chemotherapy is usually an outpatient procedure. It is given through an injection or drip, and therefore, it is called intravenous chemotherapy.

The drug can be administered through:

• Cannula- It is a short, thin tube that a nurse will put into a vein in the arm or hand.

• Central Line- It is a fine tube that goes up into a vein in the chest.

• PICC (Peripherally Inserted Central Catheter) Line- A fine tube put into a vein in the arms and goes up into the vein in the chest.

Chemotherapy is usually given in cycles of treatment, and the cycle usually takes three weeks.

If the BEP is given to the individual, they must go to the hospital for three to five days as an outpatient. Sometimes, the individual is asked to stay overnight. Weekly outpatient visits for the rest of the treatment cycle will follow this.

What Are the Possible Side-Effects of Chemotherapy?

Chemo drugs will attack the cells, dividing quickly, which is why they work against cancer cells. However, division also occurs quickly in the bone marrow, the linings of the mouth and intestine, and the hair follicles. Chemo will likely affect these cells, too, which can lead to certain side effects.

The side effects depend on the type and dosage of drugs and how long they are given.

The side effects include:

• Nausea and vomiting.

• Diarrhea.

• Loss of appetite.

• Mouth sores.

• Hair loss.

• There is an increased chance of infection due to too few blood platelets.

• Easy bruising or bleeding.

• Extreme tiredness, fatigue.

While treating testicular cancer, some of the drugs might have side effects. A few examples are:

• Kidney damage can be caused by the drugs Cisplatin and Ifosfamide. Giving lots of fluids intravenously into a vein before and after taking the drug can lessen the damage.

• There can be numbness or tingling in hands and feet and sensitivity to hot and cold due to the drugs Cisplatin, Etoposide, Paclitaxel, and Vinblastine as they damage the nerves. Once the treatment is stopped, this can improve, but it may last a long time for some individuals.

• There can also be loss of hearing due to the drug Cisplatin.

• There can be bleeding from the bladder due to the drug Ifosfamide. Plenty of fluids can be given to the patient to prevent this, and Mesna is given along with Ifosfamide.

The drugs that are used to treat testicular cancer can sometimes cause long-term side effects such as hearing loss and kidney or lung damage. There can be a higher risk of heart problems later in life in individuals who have had chemo for testicular cancer.

Conclusion

Chemotherapy is a therapy that helps to kill cancer cells throughout the body. If testicular cancer comes back after it is treated with standard dose therapy, high-dose chemotherapy with carboplatin and etoposide can be used.