Further surgery for testicular cancer

Usually, the only surgery that is needed is an orchidectomy (removal of a testicle) (see ‘Orchidectomy‘). However, further surgery is sometimes needed to remove cancer cells that have spread to other parts of the body.

If not diagnosed in its early stages, testicular cancer may spread to the lymph glands. Two men we spoke to told us that they had needed a second operation in the groin area, quite soon after the initial orchidectomy, because doctors found that cancer cells had spread to nearby lymph nodes. One said that the cancer had spread up the spermatic cord.

Explains that he needed further surgery to remove a secondary tumour in the groin area.

Age at interview 32

Gender Male

Age at diagnosis 27

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Yeah when I discovered my tumour marker levels had risen again they looked at the specimen that was removed from the first surgery and it was explained to me that the tumour had spread up the spermatic cord and where they had removed, they had cut through an area of what looked like under the microscope an area of tumour. And they recommended that I have another surgery to remove further up the spermatic cord, to try and catch where they think it had spread to, which is what happened. I can’t remember how soon after, very soon afterwards, again I went to the same surgeon at my local hospital, who removed further up the spermatic cord. And it was like another, I thought it was going to be another ‘wait and see process after that again but after I had convalesced for a couple of weeks and going through, the same another, another 15 staples in the same area. It took a little bit longer to recover the second time around because it was a second opening in exactly the same area. And it definitely took me I would say three or four weeks to be able to walk around comfortably again in that area. My oncologist said then that because they had discovered that the tumour had spread, that I was going to have to have chemotherapy.

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Chemotherapy or radiotherapy is usually used to kill cancerous tumours in the abdomen, but sometimes doctors are not quite sure whether or not these treatments have been successful. In this case the surgeons may decide to remove the remains of a tumour to make sure there are no remaining cancer cells in what appears to be a non-cancerous lump.

Surgery to remove lymph glands in the abdomen may be quite a big operation. Some men were surprised when they heard that they would be in hospital for 8-10 days. One man recalled his recovery on the ward. He remembered his drips, his catheter, and a drain in the side of his stomach, and the morphine pump that was available for pain relief.

Describes his surprise when he was told he would need 8-10 days in hospital for surgery to remove…

Age at interview 25

Gender Male

Age at diagnosis 22

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So I saw the urologist and he said “Yes you know well take it [the tumour] out, it’s ,” and I think I said “So will I be in and out?” because with the first operation I was in and out within a couple of days, so I said “Oh, will I be in and out within a day then?” And he said “No, probably 8 to 10 days you’ll be in hospital for.” I thought you’re joking. And he said, “You probably won’t be able to eat for about 8 days either. And I was like, What!’, I just couldn’t comprehend that they were going to do something that drastic. So I was like, Oh great. By this stage I thought, I didn’t think Oh God, it wasn’t like I was told I’ve got to have chemotherapy, you know you’ve got cancer, it was a case of, by that stage it was okay it’s [the tumour] probably dead, this is another thing I’ve got to do, you know hopefully the finally step to make sure I’m clear of it.

And so I went in, it was the same hospital I had the chemotherapy at, and I went in and I was there for I think for a day and then I was put on like a, a bit like the same sort of stuff I take for weight training, it’s just like little protein milkshakes to sort of empty your stomach. Because basically what they were going to do was cut me open from sort of here to here, er top to bottom, remove my stomach, remove my bowel, obviously cut out all the tumour because that’s where the tumour was all sort of hidden all the way, right at the back, next to the spine on the lymph nodes. Rip all that out, then put everything back in again and that was why I couldn’t eat for a couple of days because they say whenever they touch your bowel it affects your, the way everything works and you’ve got to slowly let that come back sort of come back into use slowly. So I had, I had an operation, my Dad was there, obviously I went and they tried to give me an epidural, which didn’t work because the muscles in my back were too thick and they couldn’t get the needle through (laughs). But it didn’t stop them trying 2 or 3 times so that hurt a little bit. And the next thing I knew I woke up in intensive care which was, is a precaution after having an operation like that, they will automatically put you in intensive care.

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Describes his experiences on the ward after a major operation to remove a tumour in his abdomen.

Age at interview 25

Gender Male

Age at diagnosis 22

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So I then, next thing I knew I woke up back in the hospital in the normal ward. I had a tube up my nose, I had a drip in my neck er I had a drip in my arm, no I had a drip in both arms, had a catheter in, I had a drain out the side of my stomach so I was a, I was really wired up. And I had, I had morphine on tap with a little button which was quite nice but you could only put in so much at a time which was a bit unfair I thought. I was in quite a bit of pain, I was just rigid on my back because as you can imagine they’d cut through all of, really the whole front of your stomach so I couldn’t obviously really roll around or lift myself up at all. I was probably like that for a day and a half. I did hallucinate a little bit on the morphine, which is a bit weird.

Yes and when they did start to bring me back onto food it was, I was only allowed like a ration of water, this much at a time, like every hour er and then I might have been allowed some Cornflakes or something like that. But I think I, I snuck a bit too much water and, and I was sick. And as you can imagine I was bent over, you’ve just had that operation, you know your stomach goes all, oh I was holding myself in going “No,” and all that came up was green which you probably didn’t really want to know but (laughs). It’s funny some of the colours that are inside you and you don’t appreciate they’re there, they’re not particularly nice. But so I slowly, within 4 or 5 days I was back on my feet, walking round the hospital, wondering when can I go home because it was doing my head in being stuck in there for so long.

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Another man we interviewed had an operation to remove a tumour, which was lying beside the aorta (blood vessel) in his back. It was a major operation because it was hard to reach the tumour. He described the incision, which was held together with staples, and the fourteen-inch scar.

Describes surgery to remove a para-aortic node and describes the big scar.

Age at interview 38

Gender Male

Age at diagnosis 35

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Yes, and that was, that CT scan was, I think it was probably two months after that – I imagine – but in February 2000 I went, they found a um, is it a PND I think is the name, it’s a node, para-aortic node and I was in hospital for ten days, they had to remove that and that was towards my back. But to get to it they had to go in from my front so I had another operation which I suppose was a bit more worrying because the reason why they had to take it out was, it turned out to be a benign tumour was, they weren’t sure if it was cancerous or not.

It wasn’t cancerous?

It wasn’t cancer no, but they had to remove it.

How long, how big was the incision?

I think its about fourteen, fourteen inches long the actual, I call it my shark bite! But I had, I was in hospital for I think for nearly ten days, twelve days I was in hospital for and I came out of hospital and I mean again once I had the operation I was, it was uncomfortable. But because, there wasn’t any of the drugs you know, it wasn’t too bad. And, and they stapled me, I had forty odd metal staples in my stomach when I came out which I thought was quite amusing!

How long did they have to stay in?

They only had to stay in probably for about a week afterwards and then a nurse came to remove them. But that, that, that took time to, to get over because it was a big cut and a big operation I suppose and even now I mean this was what nearly two years ago I had this operation now, um, you know its still, its still taking time to heal. It takes time for the scar tissue to heal as well. Even the first operation you know when I had my testicle removed, I still get aches in that area but you know you speak to doctors, I mean I go back every three months you know to the hospital for my check-ups, they said that’s, that’s fairly straightforward you know its fairly normal.

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Sometimes it is necessary to remove a rib so that surgeons can reach a tumour. Having had such a major operation, a man recalled his time in intensive care, linked up to heart monitors, breathing apparatus and pain management systems.

Describes major surgery to remove the lymph glands along the back of his spine.

Age at interview 22

Gender Male

Age at diagnosis 15

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At this point it’s February and I’ve had all my chemotherapy and they decided that the cancer had shrunk enough that I needed to stop, I could stop the chemotherapy but not quite enough that my treatment was over. And they decided at that point that it would, the best thing to do would be to remove the lymph glands along the back of my spine which is where my cancer was and remove all the residual tumour. So I was taken away, 2 or 3 weeks after my last treatment, to another big hospital and booked in for my operation.

And the consultant or the surgeon that I saw was, was very, very good. I spoke to my other consultant about him and he is world renowned for this particular operation that hes researched and hes developed himself with his team. And he came down and spoke to me and told me what I was going to have done. And it was a bit of a daunting prospect really because it wasn’t like the first operation, this was a very major operation. It involved 6 hours of operation under general anaesthetic, it was a very large scar, 18 inches and the removal of a rib and the collapsing of a lung to actually get to the site. Because obviously where the tumour is you can cut straight through, you can go through the front and go through the stomach and everything which causes complications. You can’t go through the back because you’ve got the ribs and the spine in the way so hes found a way of doing it through the side which involves a rather weird shaped scar along my side. But they go in and they collapse the lung, remove the ribs so they can get in there and then remove all the tumour.

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Describes his experience of the intensive care unit after major surgery.

Age at interview 22

Gender Male

Age at diagnosis 15

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I had 4 units [of blood] before I went in and then being such a major operation I did have going into the double figures of blood units transfused whilst I was actually in there. And then I came, woke up from that and I was in the ICU [intensive care unit] section of the hospital being monitored very, very closely.

I was linked up to heart monitors and various different breathing apparatus and pain management systems. And spent the next 6, 7 hours just lying there not really being able to move much, being in quite a bit of, not pain but discomfort from this large scar that I had on my side. And not allowed to eat or drink anything again which really annoyed me. I was only allowed to, I was allowed to suck on ice cubes and little foam lollies with water in. So my Mum spent the next 6 hours doing that for me. And then that morning they decided I was well enough to move back down to the general ward. So I was taken back down there and given a personal pain relief system which was very, very good. Which involved a needle in my arm and going through to a box containing the drugs and a button that I could press when I was in pain to administer a dose of pain killer, which was very good, it really helped.

The scar took probably 2, may be 3 weeks to completely heal over. I had stitches in that that were removed by my GP. And then after the operation, approximately 6 weeks later I was discharged from the surgeon’s care,who decided that everything was going okay.

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Laparoscopic retroperitoneal lymph node dissection (LRPLND) can now be done using keyhole surgery, but this is still quite a new operation and needs an experienced surgeon to perform and therefore is not commonly done yet. It does have more side effects than the conventional surgery but the benefits are a shorter stay in hospital (about 4 days) and a quicker recovery time. Side effects can include injury to a blood vessel, damage to the bowel, bleeding, incomplete removal of the cancer, and a risk that the cancer could come back. Your doctor should explain the risks and uncertainties before you make a decision.

This is very complicated surgery and NICE (National Institute for Health and Care Excellence) states it should only be done by experienced surgeons.
Rarely, a new tumour appears in another part of the body. One man developed a tumour in his neck two years after his initial treatment. The tumour was found by his doctor when he went for his regular follow up appointment, and was successfully removed.

Explains that he had further surgery to remove a tumour in his neck, found when he went for a…

Age at interview 40

Gender Male

Age at diagnosis 34

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And I started your normal five years remission and then unfortunately about the second year into my remission I had a reoccurrence in my neck.

Oh dear.

So they, which is you know they’re very good, so thorough in the examinations, blood tests and x-rays and scans, they picked it up straight away. I went in for a biopsy at a local hospital and the surgeon removed it all, took it away. I didn’t know that at the time, I just thought I was going in for a…

Biopsy?

Yeah but he took it all away. I went back for the results, expected to hear that you know may be it had come back, may be it hadn’t and he said no, the surgeons had taken it all away anyway, so nothing to worry about there. And now I think I’m in my fourth year, I’ve still got one in my stomach but it’s not doing anything, it’s just there so they just like to keep an eye on it.

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Occasionally, surgery is needed for other reasons. For example, one man had a laparoscopy to make sure he didn’t have an undescended testicle. During a laparoscopy a scope is put into the abdomen so that the surgeons can see that everything looks normal.

Another man had a bronchoscopy, thoracoscopy and a mediastinoscopy to make sure that the tumours in his chest that were seen on X-Ray weren’t cancerous. These are procedures that allow the doctor to look inside the lungs and chest. The thoracoscopy and mediastinoscopy involved an incision in the side of his chest, under anaesthetic. He found the investigations unpleasant, and needed a week in hospital.

Explains that he had more investigations to make sure the cancer had not spread to his chest and…

Age at interview 46

Gender Male

Age at diagnosis 42

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So, in order to make the diagnosis, what was necessary was to have what’s called thoracoscopy which means a procedure where the chest is opened up and a scope is put inside in order to take biopsies. In addition to a mediastinoscopy where a scope is pushed down behind the sternum or breast bone and samples are taken of the lymph glands around the heart. So they did appear to be rather unpleasant procedures but in the end I felt probably this was the lesser of two evils because without, I mean number one, if in fact I didn’t have secondaries, without the biopsy evidence I would be placed in a high risk group, I would need to have intensive chemotherapy and also I’d be uninsurable and possibly unnecessarily so. So in the end I thought let’s go ahead. I was referred onto a hospital in London because these procedures are not done locally. I went down, were going on about 6 weeks after the initial diagnosis, went down to talk to the surgeon, he had a look at my films and agreed that a biopsy would be appropriate. I came in a little while after that, I have to say I was well received there and well looked after. I spent a week in total in hospital because as I discovered these procedures are very much more unpleasant than for the example the equivalent in the abdomen. If you have a laparoscopy you can often go home the same day but a thoracoscopy is quite a big deal.

Where exactly were the incisions?

The incisions er I had a single scar on the side of my chest where the scope was put in, they have to separate your ribs to get it in so the external scar is quite small but then internally there was quite a large scar. I had to have an incision across the top of the sternum so effectively right across my throat. It has properly healed up, it’s not visible now. So that was the thoracoscopy and the mediastinoscopy and a bronchoscopy where they pass a scope down into your lungs and they have a look around the bronchial tree

It’s quite major.

Bronchoscopy doesn’t involve any incisions. The rest of it was quite an invasive procedure. As I say I’m quite glad that I had it done because it turned out that the nodes which were removed were not in fact malignant. Now there was a lot of debate as to what they actually were and to be honest with you to this day I don’t, I still don’t know what they were. They were described as caseating granulomas.

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Orchidectomy (testicle removal)

When cancer is suspected the best way to confirm the diagnosis is to remove the entire testicle, an operation called an orchidectomy. This is almost...

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...