Testicular Cancer Management, Follow Up And Prevention

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
Clinical Stage	Procedure	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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