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TESTICULAR CANCER

Testicular cancer is a rare neoplasm that arises from the testis. It commonly presents as a painless testicular mass.

It has high prevalence in young and middle-aged men in the age of 15-40 years old.

It is a highly treatable disease with a high cure rate.

Testicular primary germ cell tumors coming from the malignant transformation of primordial germ cells make up 95% of all testicular cancer.

 

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
    nonseminoma active surveillance

    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
    nonseminoma after adjuvant chemotherapy or RPLND

    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
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