The first treatment is surgery to remove the testicle. After 6 to 8 weeks, tests will be done to find out if your cancer is low-risk or high-risk. Some men who choose surveillance will need more treatment. But any of the three choices will cure the cancer in about 99 out of 100 men with nonseminoma cancer.1
For men with low-risk (stage IA) nonseminoma, cancer comes back in about 20 to 30 out of 100 men.2 Most experts agree that surveillance is the preferred option for low-risk nonseminoma.
For men with high-risk (stage IB) nonseminoma, cancer comes back in about 50 out of 100 men.2 Experts disagree on the best treatment for high-risk nonseminoma. Many recommend chemotherapy, some recommend surveillance, and a few recommend lymph node surgery.
Surveillance means that you are being watched closely by your doctor but are not having further treatment.
You have exams, chest X-rays, and blood tests regularly during the first few years, as well as CT scans. It can be hard to go to the doctor's office that often. Unless your cancer comes back, the number of checkups and tests will gradually decrease over the next 10 years.
With surveillance, you may be able to avoid the risks and side effects of lymph node surgery or chemotherapy.
Even when cancer is found after a period of surveillance, it is almost always possible to cure if it's found early. Because of this, most experts consider surveillance the preferred option for men with low-risk cancer.
Chemotherapy, often called "chemo," is the use of very strong drugs to kill cancer cells.
A short course of chemo has been designed for stage I nonseminoma cancer, especially for men who have high-risk cancer. Several medicines are used.
Lymph node surgery
The full name for this surgery is retroperitoneal lymph node dissection (or RPLND). It is surgery to remove lymph nodes in the lower back and pelvis. These lymph nodes may contain cancer.
During the early phases of the cancer, it can be very hard to tell if these lymph nodes have cancer without taking them out. In the past, doing this often caused infertility. Modern nerve-sparing methods have greatly lowered the chances of infertility.
Having this surgery isn't routine treatment for stage I nonseminoma. But if you and your doctor decide that this treatment is the best option for you, think about having it done at a hospital where many of these surgeries are done.