Radiotherapy for testicular cancer
Radiotherapy uses high energy x-rays to treat cancer cells. For testicular cancer, you usually have external radiotherapy. This means using a radiotherapy machine to aim radiation beams at the cancer.
When you might have it
You might have radiotherapy for seminoma cancer that has spread to the lymph glands at the back of your tummy (abdomen). These are called the retroperitoneal lymph nodes. The treatment helps to reduce the risk of the cancer coming back in these lymph nodes. Seminoma is a type of testicular cancer.
Your doctors carefully plan exactly where you need the treatment. This is called the treatment area. For testicular cancer, the treatment area is usually a strip down the middle of your abdomen.
In some situations, you might have radiotherapy if chemotherapy is not suitable for you.
Planning your radiotherapy
The radiotherapy team plan your external radiotherapy before you start treatment. This means working out the dose of radiotherapy you need and exactly where you need it.
Your planning appointment takes from 15 minutes to 2 hours.
You usually have a planning CT scan in the radiotherapy department.
The scan shows the cancer and the area around it. You might have other types of scans or x-rays to help your treatment team plan your radiotherapy. The plan they create is just for you.
Your radiographers tell you what is going to happen. They help you into position on the scan couch. You might have a type of firm cushion called a vacbag to help you keep still.
The CT scanner couch is the same type of bed that you lie on for your treatment sessions. You need to lie very still. Tell your radiographers if you aren't comfortable.
Injection of dye
You might need an injection of contrast into a vein in your hand. This is a dye that helps body tissues show up more clearly on the scan.
Before you have the contrast, your radiographer asks you about any medical conditions or allergies. Some people are allergic to the contrast.
Having the scan
Once you are in position your radiographers put some markers on your skin. They move the couch up and through the scanner. They then leave the room and the scan starts.
The scan takes about 5 minutes. You won't feel anything. Your radiographers can see and hear you from the CT control area where they operate the scanner.
Watch our video about radiotherapy planning. It is just under 3 minutes long.
Dan (radiographer) : Radiotherapy planning will involve you coming for an appointment for a CT scan in the radiotherapy department. The idea behind this is that the doctor needs to work out exactly where needs to be treated and where we need to avoid and so that scan starts us off on that process.
For the CT scan, most of the time no preparation is needed beforehand but if any is then you’ll receive that in a letter so for example, depending on what you having treated there might need to be a contrast agent introduced or you may need to have a full or an empty bladder depending on what is necessary for the scan.There are a number of things we do to help people keep still and make sure the cancer is treated.
It is important that you lie in the same position every time you have treatment. This is to make sure the radiotherapy is directed at the cancer and normal tissues are avoided. We may put equipment in place to fix your position. If you are having radiotherapy for a head and neck cancer you will have a mask made. The mask helps you to keep your head really still during treatment. We also line up the scanner and mark your skin with a felt pen where the light lines from the machine need to be aimed.
They’ll then leave the room and start the scanner and that scan lasts usually about 2 to 3 minutes. Because pen marks can rub easily the radiographer makes them permanent after your scan by tattooing very small marks on your skin.
After the scan the radiographers will give you any information that you need before starting treatment and answer any questions that you’ve got then you are free to go home.
Patient: When I came for the first meeting to plan the treatment. It was a case of having a scan and then lying, remaining on the scan machine and then the technicians took some measurements some dimensions and when they were satisfied that they had the right angles they tattooed me.
Dan (radiographer): The next part of planning is your doctor looking at the scan and marking out on the computer where you need treatment. Once that’s been done a physicist or a dosimetrist will start to plan your treatment. And they use very powerful computers to work out exactly what dose needs to be given and from which directions it needs to come on from.
Ink and tattoo marks
The radiographers make pin point sized tattoo marks on your skin. They use these marks to line you up into the same position every day. The tattoos make sure they treat exactly the same area for all of your treatments. They may also draw marks around the tattoos with a permanent ink pen, so that they are clear to see when the lights are low.
The radiotherapy staff tell you how to look after the markings. The pen marks might start to rub off in time, but the tattoos won’t. Tell your radiographer if that happens. Don't try to redraw them yourself.
After your planning session
You might have to wait a few days or up to 3 weeks before you start treatment.
During this time the physicists and your radiotherapy doctor (clinical oncologist) decide the final details of your radiotherapy plan. They make sure that the area of the cancer will receive a high dose and nearby areas receive a low dose. This reduces the side effects you might get during and after treatment.
Having radiotherapy
You have radiotherapy in the hospital radiotherapy department in short sessions (called fractions). You usually go to the hospital for treatment once a day, from Monday to Friday, with a break at weekends. The whole course normally lasts around 2 to 3 weeks.
Your doctor will tell you more about your radiotherapy treatment and how long you have treatment for.
The radiotherapy room
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your 
will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.
Before each treatment session
The radiographers help you to get onto the treatment couch. They help position you on any equipment you are using for the treatment. Because your position is so important, the radiographers may take a little while to get you ready. You can help by trying to relax as much as possible during this time.
The radiographers line up the radiotherapy machine using the marks on your body. Once you are in the right position, they leave the room. This is so they are not exposed to the radiation.
During the treatment
You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Side effects of radiotherapy for testicular cancer
Side effects tend to start a few days after the radiotherapy begins. They gradually get worse during the treatment. They can continue to get worse after your treatment ends. But they usually begin to improve after 1 or 2 weeks.
Everyone is different and the side effects vary from person to person. You might not have all of the side effects mentioned.
Your doctor and radiographers will let you know what to expect but do let them know if you have any side effects, They can help you manage them.
Feeling tired and generally weak
Tiredness often starts during your treatment and can continue for a few weeks after your treatment has finished.
You might also feel weak and lack energy. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
Sore skin and skin changes
A skin reaction can make your skin red or look darker in darker skinned people. It can also be sore, itchy, or look like sunburn, and it might peel and blister.
Skin reactions don't develop straight away but gradually throughout your course of radiotherapy. Your radiographer looks out for these reactions. But you should also let them know if you feel any soreness. They can let you know what you can use to treat the soreness. Skin reactions usually settle down 2 to 4 weeks after your treatment ends.
Feeling sick or being sick
You usually have radiotherapy to your tummy (abdomen) if you are having treatment for testicular cancer which can cause sickness.
Sickness can usually be well controlled with medicines. Your radiotherapy doctor can prescribe anti sickness tablets for you to take. Some people find that it helps to take an anti sickness tablet about 20 to 60 minutes before having treatment.
Other people find they manage better by taking anti sickness tablets regularly throughout the day. They do this during the course of their treatment. You can discuss which would be best for you with your radiotherapy team.
Diarrhoea
You might have during or after radiotherapy to your abdomen. You might also have stomach cramps and wind.
It is unpleasant to have diarrhoea and it can also make you feel weak and tired, so rest if you need to. It is important to let your radiographers and doctors know if you have diarrhoea.
There are several things that can help you, such as:
- anti diarrhoea drugs, which your healthcare team can give you
- anti spasm medicines from your healthcare team
- drinking plenty – this is important as you can easily get dehydrated
The effects on fertility
If you have radiotherapy for testicular cancer, you usually have treatment to the lymph nodes in the tummy (abdomen). The radiographer directs the beams:
- at an area down the middle of the stomach or abdomen
- sometimes at the groin
A shield protects the testicle from the radiotherapy beams. But there is a small risk that your remaining testicle could get a dose of radiation.
Doctors advise that you use contraception during treatment and for about a year afterwards. Your doctor will give you more information and explain the precautions you should take and how long you need to take them. Your doctor will also speak to you about sperm banking.
Possible late side effects
Some side effects can start years after the end of treatment. For testicular cancer, there is a:
- risk of heart problems
- small increased risk of developing a second cancer
Your radiotherapy doctor will tell you more about this.
