Follow-up Care For Patients With Testicular Cancer

Doctor in discussion with patient in exam room
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The treatment for testicular cancer can vary greatly depending on the type and stage of the cancer. Treatment includes surgery to remove the cancerous testis, which may be followed by chemotherapyradiation therapy or further surgery to remove lymph nodes.

What Happens After Treatment?

After treatment is completed, followup typically consists of office visits as well as blood and imaging tests. The primary purpose of followup is to uncover any relapse of the cancer.

Even though testicular cancer can still be cured even in advanced stages, the outcome is likely to be better if the cancer is more limited1.

The secondary purpose of followup is to address any issues or problems that may have arisen as a result of treatment. These can include complications from chemotherapy, such as lung problems, nerve damage in the hands and feet or kidney problems. There may be infertility issues due to treatment that require counseling, referral or other interventions.

The Office Visit: Review of Systems and Physical Examination

During the office visit, certain questions are asked followed by a physical examination. Both are directed at identifying any symptoms or signs which may indicate a recurrence of the cancer or that may be a result of the treatment for the cancer.

  • Review of Systems: The review of systems is the process of asking specific questions to assess certain body systems and symptoms possibly related to cancer or its treatment. The questions are formulated to ascertain whether there is any new or progressive symptom that could be evidence of recurrent cancer. For example, lower back pain could be a sign that the cancer has spread to a group of nodes know as the retroperitoneal lymph nodes, so you may be asked if you have lower back pain. Testicular cancer can spread to the lungs resulting in cough and shortness of breath so you may be questioned about these symptoms. Multiple other questions may be asked as well, but nearly all are directed at searching for evidence of cancer or complications from its treatment.
  • Physical Examination: The physical examination is also geared towards looking for evidence of cancer. Multiple systems and areas are typically examined. The abdomen is assessed through palpation (pressing and feeling with the fingers). If the retroperitoneal lymph nodes are sufficiently enlarged, they may be felt as an abdominal  mass. The lungs are assessed through listening with a stethoscope paying attention for any abnormality which could signal lung involvement by the cancer. The remaining testis is palpated. This is done primarily due to the fact that a second episode of testicular cancer is more common in someone who has already had testicular cancer. Other parts of the physical examination may include assessment of such things as assessing other lymph node groups and listening to the heart.

    Laboratory Evaluation

    In addition to the review of systems and physical examination, evaluation in the office typically involves a series of blood tests as well. Blood tests are performed primarily to look for specific tumor markers which may be elevated if the cancer is still present in some other location such as lymph nodes or lungs. Blood tests may also be done to assess complications from treatment like chemotherapy. These could be blood tests to assess kidney or marrow function, which may be affected by chemotherapy to varying degrees and durations.

    Imaging Studies

    Probably the most definitive aspect of followup care is the performance of certain imaging studies. The type of study and frequency depends on the stage and treatment of the cancer. One of the most common imaging studies is the chest x-ray.  This is done to see if there is cancer in the lungs. If cancer was in the lungs previously and treated with chemotherapy or if there are worrisome pulmonary symptoms, oftentimes a chest CT scan will be performed in place of an x-ray.

    CT scans have greater resolution and are more sensitive, but they do cost more and involve significantly more radiation than a x-ray. CT scans are commonly done of the abdomen and pelvis to specifically look for cancerous involvement of the retroperitoneal lymph nodes.

    Frequency and Duration of Follow-Up Assessments

    How often and for how long follow-up assessments occur is a decision that ultimately takes place between the patient and his cancer professionals. Guidelines from different societies typically recommend visits every 3-12 months for at least 5 years. How often and how many CT scans and x-rays are done varies depending on the stage, type, and treatment of testicular cancer. The number of CT scans typically ranges from 2-10 for the first 5 years following treatment.

    1. http://www.ncbi.nlm.nih.gov.xlib1.intermountain.net/pubmed?term=9053482

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