What to Know About Surgery for Testicular Cancer

Surgery is usually the first treatment for testicular cancer. This is usually followed by either radiation or chemotherapy. If you have early stage testicular cancer, you may not need other treatments.


Preparing for testicular surgery

A urologist will perform your surgery for testicular cancer. You meet with your surgeon beforehand to talk about what to expect. Be ready to ask any questions and address any concerns you may have about the surgery during this meeting. Be sure to ask any questions you have about the anesthesia. Ask your doctor what side effects you may have after surgery. Talk about the risks of the surgery. Ask your doctor what your recovery will be like and when you can return to your normal activities.

If you wish to have children in the future, you should talk to your doctor about how the surgery could affect your fertility. Many men decide to preserve a sample of their sperm before treatment for testicular cancer. This is called sperm banking. If the treatment makes you infertile, you and your partner could use this sperm to try to conceive a child. Discuss this option with your doctor if it is a concern.

What happens during surgery for testicular cancer

Before surgery, you’ll be given anesthesia so you will fall asleep and not feel any pain. The anesthesiologist or a nurse anesthetist will meet with you before your surgery. The anesthesia specialist will ask you about your medical history, and will tell you how the anesthesia will affect you.

Your surgeon performs your surgery in an operating room. You may stay in the hospital for a few days after your operation.

The surgery for testicular cancer is called a radical inguinal orchiectomy. The surgeon makes a cut in your groin and takes out your testicle through the inguinal canal. The surgeon cuts the spermatic cord. This cord connects the testicle to your abdomen. Your surgeon removes your testicle along with the tumor, paying careful attention to avoid spreading the cancer cells during the removal process. If you have cancer in both of your testicles, the surgeon removes them both. If your doctor removes both of your testicles, you will no longer be able to make sperm, so you will be infertile. Your body will also not make enough androgens (male hormones) such as testosterone, so you'll need to take hormone supplements.

Your surgeon will not remove your scrotum. If you wish, you can have your doctor insert an artificial testicle at a later time.

Depending on the stage of the cancer, the surgeon may also need to take out lymph nodes in the back of the upper abdomen. This is called a retroperitoneal lymph node dissection (RPLND). You may have it done in a separate surgery afterwards the main tumor has been removed. It is typically done through an upper midline incision. In very select cases, the surgeon can insert thin surgical instruments through smaller incisions that can reach into the retroperitoneal cavity along with a video camera that projects onto a television monitor (known as laparoscopic surgery). The traditional midline incision approach is very well-tolerated and provides the safest access to the lymph nodes. Doctors aren't sure whether the laparoscopic approach is as safe in removing all the cancerous lymph nodes. Your doctor will discuss which approach is most appropriate for you and why. An RPLND requires great expertise and must be done by a skilled surgeon.

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