testicular%20cancer
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.

 

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
    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

Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Tristan Manalac, Yesterday
While antibody titres against SARS-CoV-2 wane with time, the immune system is capable of producing memory B-cells that can last for at least 6 months after infection, suggesting that the body will be able to protect itself in the case of re-exposure, according to a new study.
Jairia Dela Cruz, 5 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.