Javascript er ikke aktivert i din nettleser. Dette er nødvendig for å bruke Oncolex. Kontakt din systemadministrator for å aktivere JavaScript.

Follow-up care after treatment of testicular cancer

Follow-up is intended to discover early recurrence, monitor and treat toxicity caused by chemotherapy, and to offer support and help for topics such as fertility and hormone deficiency. The frequency of follow-up depends on the stage of the disease and the treatment the patient has received. In addition to imaging and blood tests, a thorough examination of the remaining testicle and superficial lymph node stations is important.

Most recurrences of testicular cancer occur in the first 1-2 years after primary treatment. Some recur after 3-4 years or later. Patients with nonseminoma who have had chemotherapy can develop slow-growing mature teratoid tumors (teratomas), especially retroperitoneally. Mature teratomas are not susceptible to chemotherapy or radiation therapy. Teratoma components of metastasizing cancer requires life-long follow-up for growing teratoma syndrome which can cause local compression problems and may transform into malignant tumors.

Patients with both testicles removed need testosterone treatment for life. This is usually done by injection of Nebido® 1000 mg s.c every 8–12 weeks.

A sperm analysis is performed on all patients one year after treatment is finished.

Follow-up schedule for Testicular Cancer

Seminoma (10)

Recommendation for seminoma stage I - IV and recurrence:

1. year 2. year 3-4. year 5. year 6-10. year

Clinical examination

Every 4. month

Every 4. month

Every 6. month

Every 12. month

Every 12. month

Tumor markers

Every 4. month

Every 4. month

Every 6. month

Every 12. month

Every 12. month

Chest X-ray

At 12 months

At 24 months

At 36 months

At 60 months

At 10 years

MRI abdomen/pelvis

Every 4. month

Every 4. month

Every 6. month

Every 12. month

Every 12. month

Testosterone, lipids, glucose

At 12 months

 

At 36 months

At 60 months

At 10 years

Blood pressure

At 12 months At 60months At 10 years

All patiens with seminoma are followed up for 10 years. At the final medical control, at 10 years, the patient receives final written information. If the MRI availability is limited, CT may be used. The number of CT examinations should not exceed 10 in the control period.

Non-seminoma (10)

The follow-up schedule varies depending on the chosen treatment strategy.

  • Observation
  • Adjuvant chemotherapy
  • Nerve sparing retroperitoneal lymph node dissection.

Follow-up observation strategy

Recommendation for nonseminoma stage I, low risk profile:

1. year 2. year 3. year 4-5. year 7. year 10. year

Clinical examination

Every 4.month

Every 6. month

Every 6. month

Every 6.month

Option

Option

Tumor markers

Every 2. month

Every 3. month

Every 3. month

Every 6. month

Option

Option

Chest X-ray

Every 4. month

Every 6. month

At 36 months

Every 12. month

Option

Option

MRI abdomen/pelvis

Every 4. month

Every 6. month

At 36 months

At 60 months

Option

Option

Testosterone, lipids, glucose

At 12 months

 

At 36 months

At 60 months

Option

Option

One can consider the follow-up at 7 and 10 years, to detect late recurrence of teratoma. At the final control (5 or 10 years) the patient receives final written information. If the MRI availability is limited, CT may be used. The number of CT examinations should not exceed 10 in the control period.

Follow-up adjuvant chemotherapy

Recommendation for nonseminoma stage I, high risk profile:

1. year 2. year 3. year 4-5. year 6-10. year

Clinical examination

Every 6. month

Every 6.month

Every 6. month

Every 6. month

Every 12. month

Tumor markers

Every 2. month

Every 3. month

Every 6. month

Every 6. month

Every 12. month

Chest X-ray

Every 6. month

Every 6. month

At 36 months

Every 12. month

At 10 years

MRI abdomen/pelvis

Every 6.month

Every 6.month

At 36 months

At 60 months

At 10 years

Testosterone, lipids, glucose

At 12 months

 

At 36 months

At 60 months

At 10 years

The patient receives written information at the final 10 year control . If the MRI availability is limited, CT may be used. The number of CT examinations should not exceed 10 in the control period.

Follow-up nerve sparing retroperitoneal node dissection (RPLND)

The recommended minimum follow-up is the same as the observation strategy.

Follow-up for nonseminoma stage Mk+, II – IV and after treatment for recurrence

Recommendation:

1. year 2. year 3. year 4-5. year 6-10. year

Clinical examination

Every 4. month

Every 6. month

Every 6. month

Every 6. month

Every 12. month

Tumor markers

Every 2. month

Every 3. month

Every 3. month

Every 6. month

Every 12. month

Chest X-ray

Every 4. month

Every 6. month

Every 6. month

Every 12. month

At 7 and 10 years

MRI abdomen/pelvis

Every 4. month

Every 6.month

Every 6. month

Every 12. month

At 7 and 10 years

Testosterone, lipids, glucose

At 12 months

 

At 36 months

At 60 months

At 10 years

Blood pressure

At 12 months

At 60 months

At 10 years

If the MRI availability is limited, CT may be used. The number of CT examinations should not exceed 10 in the control period. The patient receives written information at the final medical follow-up. Patients who have been proven teratoma in the primary tumor or in the resected tissue at retroperitoneal lymph node dissection (RPLND) should have annual follow-ups. These controls include clinical examinations and blood tests (tumor markers, hormones, blood lipids and blood glucose) supplemented with radiological examinations.

Long-term follow-up

Outpatient clinic controls

Patients are followed up to 10 years at an oncology outpatient clinic after treatment for testicular cancer, with diagnosis of recurrence as the main objective. Examination of the remaining testicle is mandatory. Tumor development in the remaining testicle can occur in 2-5% of the patients. At this medical control it is also important to diagnose and treat delayed side effects caused by the treatment.

At the last control in the oncology outpatient clinic, the patient is given a document that describes his treatment. For testicular cancer survivors emphasis is also placed on typical health risks , that is possible to reduce with preventive measures .

Medical controls and necessary measures are left to the patient's GP. The goal of this medical control is to prevent, diagnose and treat delayed side effects caused by testicular cancer treatment.

The most common delayed side effects are:

  • Cardiovascular disease. Cisplatin-based chemotherapy increases the risk of cardiovascular dicease.
  • Hypogonadism. Up to 20% experience endocrine hypogonadism/testosterone deficiency. Reduced libido, erectile dysfunction and fatigue are common symptoms. If the symptoms are severe testosterone treatment is considered. Lifelong testosterone substitution is necessary after bilateral orchiectomy and low testosterone levels after CIC (Carcinoma in citu) treatment.
  • Fertility. Abnormal sperm quality often occurs in patients with testicular cancer. In addition, chemotherapy and radiation treatment negatively affect fertility and sex hormones . Therefore, samples to evaluate sex hormones (testosterone, LH, FSH and SHBG) should be taken and sperm analysis performed before treatment. Cryopreservation of sperm should be offered. If the patient wants cryopreservation, this should preferably be done before orchiectomy, but in any case before chemotherapy. The results of a large national study of men, previously treated for testicular cancer, shows that fertility gradually diminish with increasing treatment intensity. But even among men who had accumulated high-dose cisplatin (> 850 mg), almost half of them became fathers without cryopreserved sperm.
  • Retrograde ejaculation. Retrograde ejaculation may occur in some men after RPLND, but the proportion is significantly reduced after nerve-sparing surgical technique was introduced. For men who want to become fathers, treatment with α-sympathomimetic drugs (Rinexin ®, Tofranil ® [imipramine, unregistered product]) may be an option as the drugs can reverse the retrograde ejaculation
  • Nephrotoxicity
  • Neurotoxicity
  • Ototoxicity
  • Pulmonary toxicity
  • Secondary malignancy (particularly in the gastrointestinal area)

Medical follow-up with the GP (family doctor)

Regular medical controls with the patient's GP are recommended 2-3 years after the follow-up with an oncologist. Thereafter, the recommendation is every 2-3 years, more frequently in patients with pathological findings.

The medical control should include:

  • Medical history with regard to symptoms of cardiovascular disease
  • Measurement of blood pressure, height / weight (BMI), waist circumference
  • Blood samples:
    • Fasting blood lipids (total cholesterol, HDL and LDL cholesterol, triglycerides)
    • Glucose
    • Testosterone
    • LH
  • Lifestyle advice with focus on smoking, diet and physical activity
  • Prophylaxis of cardiovascular disease according to current guidelines
  • Testosterone substitution in proven hypogonadism, possibly in consultation with the endocrinologist

Oslo University Hospital shall not be liable for any loss whether direct, indirect, incidental or consequential, arising out of access to, use of, or reliance upon any of the content on this website. Oslo University Hospital© 2017