Last updated: 10-Oct-2026
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IN SHORT
When testicular cancer has reached the lymph nodes at the back of the abdomen, or further, cisplatin-based chemotherapy is the main treatment, and it works well for most men.
AFP, hCG and LDH are followed through the cycles. A marker that rises during or after chemotherapy is never just watched: you are restaged and discussed the same week.
After chemotherapy, the tumour type decides. In non-seminoma, a leftover mass of 1 cm or more is removed. In seminoma, only a PET-positive mass of 3 cm or more.
The testis has been removed. The CT and the markers after surgery are back. The tumour board has found spread: to the lymph nodes at the back of the abdomen, or beyond them, for example to the lungs. What the stage and risk group mean is explained in testicular cancer stages and risk groups. This page is about the treatment that follows.
Not every man with node spread needs full chemotherapy. In seminoma with normal markers and nodes up to 3 cm, smaller options are accepted in selected men. These are a nerve-sparing RPLND, or focused radiotherapy with one dose of carboplatin. Larger nodes, or spread beyond them, mean cisplatin-based chemotherapy.
Some young men arrive very unwell: breathless, with a large mass in the abdomen, or an hCG in the thousands. Bleeding into the lungs can follow. Chemotherapy is then started urgently, even before the testis is removed. Pressure on the spinal cord, a blocked main vein in the chest, or kidneys failing because a node mass blocks the urine tubes are also same-day problems.
The standard treatment is BEP: bleomycin, etoposide and cisplatin, given in cycles. Your risk group sets how many: three cycles in the good-risk group, four in intermediate and poor risk. When bleomycin is not suitable, four cycles of EP replace three of BEP. In good-risk seminoma with an LDH more than 2.5 times the upper limit, most men now receive four cycles rather than three.
The cycles are kept on time. Doses are not cut. Cycles are not postponed for low blood counts; injections that support the counts are used instead. Keeping to the schedule is part of what makes the treatment work. A stretched schedule is the commonest avoidable reason for failure.
| What is watched | Why | What follows |
|---|---|---|
| Breathlessness or a dry cough. | Bleomycin can damage the lungs. | Bleomycin is stopped for good; never one more cycle. |
| Creatinine in the blood. | Cisplatin can strain the kidneys. | Extra fluids and a dose review with the medical oncologist. |
| Hearing, ringing in the ears. | Cisplatin can affect hearing. | Hearing test compared with the baseline. |
| Tingling in hands or feet; cold, white fingers. | Nerve and blood-vessel effects of chemotherapy. | Reported and recorded at each cycle. |
| AFP, hCG and LDH. | They show whether the cancer is responding. | A rise means restaging and a tumour board the same week. |
A marker that climbs during or after chemotherapy suggests the cancer is resisting treatment or returning. It is not observed. Scans are repeated and the tumour board discusses it the same week. Second-line treatment may be standard-dose chemotherapy, or high-dose chemotherapy with stem-cell rescue. It belongs in a high-volume centre. Referral is made rather than improvising locally.
A CT after chemotherapy shows whether a mass remains. What is done with it depends on the tumour type:
| Tumour type | Mass left after chemotherapy | What is advised |
|---|---|---|
| Non-seminoma, markers back to normal. | 1 cm or more. | Removal by RPLND, because it may hold teratoma, which chemotherapy cannot shrink and which can grow or change. |
| Seminoma. | 3 cm or more. | A PET-CT at least six to eight weeks after chemotherapy; surgery only if it is PET-positive. |
| Seminoma. | Smaller, or PET-negative. | Watched with scans. |
| Late return, or a growing teratoma. | A mass that grows, even years later. | Surgery is the treatment; chemotherapy will not control a growing teratoma. |
PET-CT has no role for a leftover mass in non-seminoma; that decision rests on size and markers.
Fertility and nerve-sparing are covered in more depth on the testicular cancer surgery and fertility page. Reports can be sent ahead, so the consultation starts with them already read. Treatment is decided at the consultation, after examination.
Yes. This cancer usually responds well to chemotherapy even after it has spread. Your own outlook depends on your risk group and on completing every cycle on time.
Keeping the dates is part of what makes the treatment work. Low blood counts are supported with injections rather than by delaying or reducing the dose.
Only if a mass is left that needs removal: in non-seminoma, 1 cm or more with normal markers; in seminoma, a PET-positive mass of 3 cm or more. Many men need no operation.
In seminoma it helps show whether a mass of 3 cm or more is still active. In non-seminoma it has no role, because a leftover mass may hold teratoma; the decision rests on size and markers.
It is offered to every man before chemotherapy and the answer is recorded. In almost every case at least one sample can be stored without delaying treatment.
Testicular cancer as a whole is covered on the testicular cancer surgery page.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Urology Cancer Surgeon
Consultation at the Gota OPD, Ahmedabad. Surgery at Apollo Hospital, Bhat, Gandhinagar.
Gota OPD, Ahmedabad — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
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