Testicular%20cancer Management
Follow Up
- The primary goals of follow-up during the first 5-10 yr are early detection & treatment of relapse
- Patients relapse w/in the first 1-2 yr following initial treatment & as such, frequent & intensive surveillance should be done at this time; late relapses can occur after 5 yr & thus, annual follow-up may be advised
- Cured patients have approximately 2% cumulative risk of having a cancer develop in the contralateral testis w/in 15 yr following initial diagnosis with the risk higher in seminomas than nonseminomatous primary tumors
- It should also prevent, detect & treat late toxicities of the disease, eg hypogonadism, infections, post-chemotherapy cardiovascular disease, metabolic syndrome, leukemia, second solid non-germ cell tumor, pulmonary, renal, neuro & ototoxicity
- Optimal follow-up schedule is adapted according to national & institutional requirements & is determined by the histology of the original tumor & the stage & risk of recurrence at first presentation
- Individualize follow-up based on site & biology of the disease & the length of therapy course
- Perform reassessment of disease activity in patients w/ new or worsening disease regardless of the time interval from prior studies
- Interval clinical evaluation w/ a history & PE, serum tumor markers, a chest x-ray & an abdominal or pelvic CT scan are performed on follow-up
- Physical exam or imaging studies almost always detect relapse in patients w/ seminoma
- Increased levels of tumor markers are often the earliest sign of relapse when monitoring all stages of nonseminomas & metastatic seminomas & indicate treatment even in the absence of metastatic disease on imaging studies
- Consider a chest CT scan if thoracic symptoms are present or if supradiaphragmatic disease is seen at diagnosis
- Testicular ultrasound may be done for any equivocal exam
- Listed below is the minimum follow-up schedule for testicular cancer:
Clinical Stage |
Procedure |
Year |
||||
1 |
2 |
3 |
4 |
5 |
||
Stage I seminoma surveillance after orchiectomy, chemotherapy, or radiation therapy |
History & PE |
2-4x |
1-2x |
1-2x |
1x |
1x |
Chest x-ray |
As clinically indicated |
|||||
Abdominal ± pelvic CT scan |
3x |
1-2x |
1-2x |
1x |
1x |
|
Stage I |
History, PE, & tumor markers |
6x |
4x |
2-3x |
2x |
1x |
Chest x-ray |
6x |
4x |
2x |
2x |
1x |
|
Abdominal ± pelvic CT scan |
3x |
2x |
2x |
1x |
- |
|
Stage I |
History, PE, & tumor markers |
4x |
4x |
2x |
2x |
1x |
Chest x-ray |
2x |
1x |
- |
- |
- |
|
Abdominal ± pelvic CT scan |
1x |
1x |
- |
- |
- |
|
Metastatic seminoma & nonseminoma |
History, PE, & tumor markers |
4x |
4x |
2x |
2x |
2x |
Chest x-ray |
4x |
4x |
1x |
1x |
1x |
|
Abdominal/pelvic CT scan |
2x |
2x |
1x |
1x |
1x |