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

Pregnancy, caesarean delivery complication rates high in women with NB, LUTR

24 Jan 2018

Women with neuropathic bladder (NB) and paediatric lower urinary tract reconstruction (LUTR) are at increased risk of developing complications during pregnancy and caesarean delivery (CD), with those having prolonged labour, prior CD or a history of noncompliance having the worst complications, according to a study.