Non Seminoma Testicular Cancer in Singapore

Radical inguinal orchiectomy remains the primary treatment for all testicular cancers. This surgical procedure involves removing the affected testicle and spermatic cord through an incision in the groin rather than the scrotum. The inguinal approach prevents potential cancer spread through scrotal lymphatics. The procedure takes approximately 45-60 minutes and can be performed under general or regional anaesthesia. Histopathological examination of the removed testicle confirms the diagnosis and identifies specific non-seminoma subtypes.

Standard chemotherapy for non-seminoma uses combination regimens based on disease stage and risk factors. The BEP regimen (bleomycin, etoposide, cisplatin) serves as the primary treatment for most patients with metastatic disease. Good-risk patients typically receive three cycles, while intermediate and poor-risk patients require four cycles. The EP regimen (etoposide, cisplatin) may be used when bleomycin is contraindicated due to lung concerns.

RPLND may be performed as primary treatment for clinical stage I disease with high-risk features or as post-chemotherapy surgery for residual masses. The procedure involves systematic removal of lymph nodes from the retroperitoneum through either open surgery or minimally invasive techniques. Nerve-sparing modifications help preserve ejaculatory function while maintaining oncologic efficacy.

Modern treatment utilises CT and PET-CT imaging for accurate staging and response assessment. Robotic-assisted laparoscopy enables minimally invasive RPLND in selected cases. Tumour marker assays provide real-time monitoring of treatment response. Pulmonary function testing guides bleomycin administration, while audiometry and renal function tests monitor cisplatin toxicity.

Before initiating treatment, patients undergo comprehensive staging evaluation including CT scans of chest, abdomen, and pelvis. Tumour markers (AFP, HCG, LDH) are measured to establish baseline levels. Pulmonary function tests assess lung capacity before potential bleomycin therapy. Sperm banking is offered to all patients desiring future fertility, as both surgery and chemotherapy can affect sperm production. Blood tests evaluate kidney function, liver function, and blood counts. Patients receive detailed education about their treatment plan and potential side effects.

For orchiectomy, patients receive anaesthesia before the surgeon makes a 5-7cm incision in the groin. The spermatic cord is clamped and divided high, and the testicle is delivered through the incision. A prosthetic implant can be placed if desired. For chemotherapy, patients receive pre-medications to prevent nausea and allergic reactions. Each cycle involves specific day protocols with intravenous infusions administered in the oncology day unit. Hydration protocols protect kidney function during cisplatin administration.

Following orchiectomy, patients recover for 1-2 hours before discharge home the same day. Ice packs reduce swelling, and pain medication manages discomfort. After chemotherapy infusions, patients are monitored for immediate reactions. Anti-emetics control nausea, and growth factor support may be given to maintain blood counts. Regular blood tests track tumour markers and organ function. Patients receive clear instructions about warning signs requiring immediate medical attention.

After orchiectomy, patients should rest with the scrotum elevated to reduce swelling. Pain is typically manageable with prescribed medications. Walking is encouraged to prevent blood clots, but heavy lifting is restricted. Following chemotherapy sessions, patients may experience fatigue and nausea despite preventive medications. Maintaining hydration helps flush chemotherapy drugs from the system. Temperature monitoring is crucial as chemotherapy can increase infection risk.

Surgical patients gradually increase activity while avoiding strenuous exercise. The incision is kept clean and dry, with showering permitted after 48 hours. Scrotal support provides comfort during healing. Chemotherapy patients experience peak side effects around day 7-10 of each cycle, including potential hair loss, mouth sores, and fatigue. Blood counts reach their lowest point (nadir) requiring careful infection precautions. Dietary modifications help manage taste changes and maintain nutrition.

Complete recovery from orchiectomy takes 2-4 weeks, with return to normal activities including exercise and sexual function. Chemotherapy recovery extends 3-6 months after the final cycle for energy levels to normalise. Hair regrowth begins 1-2 months post-treatment. Long-term monitoring includes regular tumour markers, CT scans, and chest X-rays following specific surveillance protocols. Testosterone levels are monitored as some patients require hormone replacement. Fertility typically recovers 12-24 months after chemotherapy completion, though this varies individually.

During chemotherapy, most patients experience temporary hair loss affecting the scalp and body. Nausea and vomiting occur despite preventive medications but improve with each cycle. Fatigue progressively increases throughout treatment, peaking after the final cycle. Taste changes and decreased appetite affect nutritional intake. Low blood counts increase infection risk, requiring precautions during treatment. Peripheral neuropathy causes tingling in fingers and toes, usually improving after treatment completion.

Bleomycin can cause lung toxicity in 3-5% of patients, requiring pulmonary monitoring and possible drug discontinuation. Cisplatin may cause permanent hearing loss at high frequencies and kidney function impairment if not properly managed. Secondary malignancies occur in less than 1% of patients many years after treatment. Retroperitoneal surgery carries risks of retrograde ejaculation affecting fertility. Cardiovascular complications including heart disease and metabolic syndrome may develop years after treatment.

Our experienced oncology team employs established protocols to minimise these risks through careful patient selection, dose modifications when necessary, and vigilant monitoring throughout treatment. Regular follow-up allows early detection and management of any late effects.