Chemotherapy for testicular cancer

Chemotherapy involves the use of anti-cancer (cytotoxic) drugs, which destroy cancer cells by damaging them so that they can’t divide and grow. These drugs can also affect normal cells that are growing and dividing, and thus may cause side effects (see ‘Side effects of chemotherapy’).

If a man has a teratoma, and if the cancer has not spread, two short courses of chemotherapy (BEP chemotherapy, for more information see Macmillan Cancer Support) may be given to prevent the cancer coming back (after the testicle has been removed). This is called adjuvant chemotherapy.

If a man has a teratoma, and the cancer has spread elsewhere in the body, two to four sessions of chemotherapy are usually given. Each session involves spending a few days in hospital followed by weekly outpatient’s visits to be given the chemotherapy drugs. If the cancer has spread to other parts of the body, a longer course of chemotherapy may be necessary. The chemotherapy drugs are given by injection into a vein (intravenously).

Interview 12 (see below) was in hospital for three days for each treatment cycle and then went home for two and a half weeks. He described the intravenous saline he was given before the chemotherapy to flush out his kidneys.

Men we interviewed who had been in this situation described their experiences of chemotherapy. Some said that the room where they were given chemotherapy looked like a ‘normal’ hospital ward. They remembered the calm atmosphere, and patients reading books or newspapers.

Describes his experience of the chemotherapy that he had to cure the spread of his teratoma.

Age at interview 24

Gender Male

Age at diagnosis 22

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And you just end up in this routine, whenever you go into hospital you need a blood test, and an x-ray, and you are examined by the doctor. And you have to wait once the blood tests have come back you know saying that you’ve got enough neutrophils to kind of, so they don’t wipe out your immune system, you’re not anaemic or anything. And they start making up the chemo and so you hang around for about 4 or 5 hours in the afternoon and then early evening they put a Venflon [a special needle] into your hand ready for the chemotherapy. I was basically kind of plugged in. And they start then filling you full of bags of various fluids and they pop it in and then you know that you can’t unplug that for 3 days. It won’t come out for any reason, if you have to bath, you have to go to the loo with it in, you can’t change your tee shirt because that’s too much hassle. Well, you can take it off if you’ve been sweating a lot or if you’re feverish or anything, but then yes solidly kind of 24 hours a day, 24 hours a day for 3 days you’re sat with this beeping machine next to you. And for the first 2 days the Venflon stays nice and clear and empty and then it starts to get a bit bunged up with this, that and the other for the final day. So often the alarms, the pressure can get too high in the tube and it starts to kind of beep at you in the middle of the night because you’re like falling asleep and rolled onto it or whatever.

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Another man recalled that when the first drug was given to him through a drip he felt a cold shiver go up his arm. One other interviewee said he had to stay in bed for the first two treatments, which he found quite restricting and uncomfortable, but during the third treatment, which only lasted for a couple of hours, he was free to wander round the hospital.

Explains what life was like in hospital when he had chemotherapy to cure the spread of his teratoma.

Age at interview 22

Gender Male

Age at diagnosis 15

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How many weeks, how many sessions of chemotherapy did you have to

have?

I had 5 sessions. The first 2 were a particularly strong form of the chemotherapy and then the third one was a much lighter form. The first 2 were continuous drugs going in all the time, through the pump overnight. The drugs are administered through cannulas into, straight into your blood stream so obviously it can be quite uncomfortable lying in bed. You have to keep the same position and then you’ve got nurses coming out, in and out every half hour, three quarters of an hour to check that everything is running through all right. So it was quite uncomfortable. But then the third treatment was only on during the day for a couple of hours and then I was free to wander round the hospital or have friends round. I mean even when I had the line up I had friends and family to visit and that sort of thing. And I used to scare the living daylights out of the women in the Comfort Fund shop at the hospital because I was told that I could, as long as I was sensible, I could walk round the hospital with my drip stand. So of course off I went into the shop and turned round and very politely asked the woman behind the desk if she minded if I plugged my drip stand in whilst I looked around. And she was aghast “What on earth is that, are you sure you’re supposed to be in here?” It was quite amusing. And I used to go down to the canteen, the staff canteen because the food in there was much nicer and I’d sit with the doctors and chat to them whilst my drip stand was going and I was eating my food which always amused the doctors. So yeah, I tried to be as normal as possible I suppose whilst I was in there.

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One man recalled that the nurses and doctors had great difficulty in finding a vein in order to put up the drip for his chemotherapy. His arm became sore and swollen because the drip had come out of the vein in his arm, and the chemotherapy had gone into the surrounding tissue. Eventually he had a Hickman line (a central line for the administration of drugs that is left in place) installed in his chest to make the administration of the drugs easier.

Explains why he had a Hickman line installed in his chest for chemotherapy.

Age at interview 33

Gender Male

Age at diagnosis 26

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The first lot of chemo I was in a ward with 4 other guys, 2 guys in their 50s walked in with brain tumours, er and obviously that first week they got progressively worse. The needles weren’t doing me any good at all, one of them actually didn’t go in the vein, it was in my flesh. And I was, I don’t know why, but you get used to levels of pain I suppose and I was rocking about on this chair with a cloth round my wrist and my Mum came in and asked, she knew straight away there was something wrong, took it off and my wrist had swollen up because it was going where it shouldn’t be and I’d not said anything. I think then they took one out and it took another 5 attempts to put another needle in. And it was at that stage that one of the nurses came to me and said, asked me if I wanted a Hickman line fitting. And a Hickman line basically is a tube about a foot and a half long I would imagine that goes into one of your main veins, one of your main arteries by your heart. And instead then of putting a needle in you every time this tube has just got a screw cap on it basically and they fasten the chemo up to it, screw it up and it goes, and it’s taken through your system. So theres no, theres no needles involved whatsoever, which was a lot better for me.

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If a man has a seminoma, and if there is no spread of the disease, a single dose of chemotherapy (carboplatin) is used (see Cancer Research UK for more information). One man described his short visit to the hospital for treatment. The drip was put up, and the only discomfort he felt was where the needle went into his wrist.

Explains what it was like to have a short session of chemotherapy to prevent cancer spread.

Age at interview 28

Gender Male

Age at diagnosis 27

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And then in June of this year they said “Right you’ve got to have further treatment, because it was cancerous you’ve got to have either a dose of radiotherapy or a shot of chemotherapy.” And to be honest with you now the hospitals have devised a new half hour shot of chemotherapy, which they’re trying, I think they’ve only recently brought in and they’re trying it out, instead of having radiotherapy. So I went in one morning in June, into the hospital, and they inject you, put a little injection in your arm, have a drip next to you and they feed the liquid chemotherapy into you and that lasted half an hour and that’s all I needed.

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If a man has a seminoma that has spread to other parts of the body, radiotherapy alone may be one way of curing the disease, but sometimes chemotherapy is considered to be a better option, particularly if the cancer has spread extensively. One man told us about his experiences of this, recalling that it was sometimes hard to sleep during the night, and how the alarm went off when he accidentally pulled the drip out of his arm.

Explains what life was like in hospital while having chemotherapy to cure the spread of the…

Age at interview 40

Gender Male

Age at diagnosis 37

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What’s it actually like having the chemotherapy in hospital?

Well you’re wired up to this portable dosing machine, which is like an electronic dosing machine. The nurses set that up and they have a bag hanging above it. And it’s a little tiny tube going into your arm you can’t actually feel it going in at all because you’re, by now you’re used to having this little tube in your arm because it stays there for the whole period you’re in hospital. And, and you get quite proficient at monitoring this machine, you get to know how much you’ve got left, you get to know the rate, you can speed the rate up if you want to try and hurry it up, the nurses let you do that. You know what the alarms are, you know how to re-set the machine and because it’s on wheels you can go for walks with this machine and its quite amusing to see lots of people wandering around with, pushing their little trolleys around the corridors and going to the canteen and going to the bookshop and everything, so you’ve got quite a lot of freedom. Difficult of a night when you’re trying to sleep because if you roll over you can kink the uh, cable or you can actually pull it out of your arm, which I did once and then the alarm goes off and the nurse has to re-do it all again in the middle of the night. But you sort of get used to it, it’s not that painful or anything at all.

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Chemotherapy may also occasionally be used to shrink down a large testicular cancer before surgery so that it can be removed more easily. This is known as neo-adjuvant chemotherapy.

Treatment for testicular cancer is very successful, and the cancer does not usually come back after standard chemotherapy. If the standard chemotherapy does not get rid of the cancer cells, higher doses of chemotherapy are occasionally needed (which is rare), with stem cell support. High doses of chemotherapy damage cells in the bone marrow, so certain cells in the blood called peripheral blood stem cells are collected and stored before treatment begins, and returned to the blood afterwards.

Explains what it was like to have high doses of chemotherapy, administered via a Hickman line.

Age at interview 40

Gender Male

Age at diagnosis 34

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How many weeks of chemotherapy did you have?

Oh I had about, crikey, it must’ve been about eight, eight weeks, probably a bit longer than that. But the chemo, your body becomes immune to it and it stops working, or it doesn’t work as good. So they suggested that I go back to another hospital and have a stem cell transplant. So again you know I just, if that’s what’s got to be done that has to be done. So I went back to another hospital.

Was that to help your immune system?

Yeah it, they take your own stem cells from you and they store them in like a freeze, freezing place and they take more than they need. And then they really give you a really high dose of chemotherapy and it’s bordering on, they virtually kill you I should think because your immune system is nil. And you have to be put in isolation, you’re not allowed to be anywhere near any germs. If anyone comes in and out of the room they have to dress up in masks and gowns and hats and everything. And this goes on for about a week and then they reintroduce your stem cells back into you and theres more good, because it’s all to do with the blood, more good cells than there are bad cells. And obviously they can overtake the bad cells. And then they count you down from I think it’s 15 days, minus 15, 14 and then when you get to zero your immune system is apparently back up and working fine. So we went through that.

Did they give a very high dose of chemotherapy?

Very high yeah.

What was that like?

Oh I mean normal chemotherapy is quite bad but (laughs) this was, I mean I had all sorts of different problems with mouth ulcers, terrible, I couldn’t eat and drink, I had to be you know, have a straw to have these build up drinks, different things. I caught a bug and crikey I can’t remember how many tablets I was taking, it must’ve been about 30 tablets a day at one time. And I had a Hickman line fitted, different things.

I think you mentioned you had a Hickman line, can you explain for other people what that is?

A Hickman line, it’s a small tube that they put in through your chest, they feed it down towards your heart. And it has about five different tubes off the end of it so they can connect different medication and drips to it at the same time.

Did you find that uncomfortable?

No it’s fine. Actually you’re awake when they put it in you know, they make a small incision in your chest and they just feed it down. You can watch it on the screen actually.

So that’s to make the chemotherapy easier to administer?

Yeah that’s right.

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