eMedicine Specialties > Urology > Cancer, Testicle

Testicular Choriocarcinoma: Follow-up

Author: Michael B Williams, MD, MS, Fellow, Department of Urologic Oncology, MD Anderson Cancer Center
Coauthor(s): Paul Schellhammer, MD, Chairman, Program Director, Professor, Department of Urology, Eastern Virginia Medical School; John W Davis, MD, Assistant Professor, Department of Urology, University of Texas MD Anderson Cancer Center
Contributor Information and Disclosures

Updated: May 21, 2009

Follow-up

Further Inpatient Care

As outlined above, most radical orchiectomies are performed in the same day or in 23-hour observation settings. This surgery is comparable to an inguinal herniorrhaphy, and the patient can expect limited physical activity for a brief period following surgery.

Further Outpatient Care

The primary management for all testicular carcinomas depends on the pathology of the tumor. As most cases of choriocarcinoma have poor risk features, primary chemotherapy, as outlined above, is followed by radiographic reassessment and staging.

Inpatient & Outpatient Medications

Following orchiectomy, a short course of pain management medication may be required.

Deterrence/Prevention

Prior to diagnosis, testicular self-examination on a monthly basis should begin at puberty.

Following diagnosis of testicular carcinoma, a mutual understanding between the patient and his treating physician in terms of strict adherence to follow-up regimens must be discussed. Early on, the follow-up regimens are frequent, as tumors can dramatically advance within short periods.

Prognosis

  • In most reports, choriocarcinoma carries a dismal prognosis.
    • Batata et al (1980) reported a 5-year survival rate of 0% (0 of 20 patients)17 . Requena et al (1991) reported a case of pure choriocarcinoma with metastases to the skin (rare), lung, and brain. This patient was treated with a 4000-rad dose to the skull and a multi-agent chemotherapy regimen, including platinum, vinblastine, and bleomycin (PVB) and lomustine, VP-16, and VePesid. The patient's beta-hCG level normalized, and he was disease-free at 2 years.15
    • Lepidini et al (1997) reported a patient treated with multi-agent chemotherapy who was disease-free at 43 months of follow-up.18
  • In 5 cases of pure choriocarcinoma with brain metastases, all patients died, and median survival was 1 month despite treatment with multi-agent chemotherapy.7
  • In a 9-year review of patients treated in multi-agent chemotherapy trials at Memorial Sloan-Kettering Cancer Center, Bosl et al (1983) reported 5 cases of pure choriocarcinoma and 2 long-term survivors.19

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Scrotal masses should be evaluated with ultrasonography if they involve the testicle.
  • Malignancies of the paratesticular structures are very uncommon and should be evaluated based on the clinical findings.
 


More on Testicular Choriocarcinoma

Overview: Testicular Choriocarcinoma
Differential Diagnoses & Workup: Testicular Choriocarcinoma
Treatment & Medication: Testicular Choriocarcinoma
Follow-up: Testicular Choriocarcinoma
Multimedia: Testicular Choriocarcinoma
References
Further Reading
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References

  1. Mostofi FK, Sesterhenn IA. Anatomy and pathology of testis cancer. In: Comprehensive Textbook of Genitourinary Oncology. Baltimore, Md: Williams and Wilkins; 1996.

  2. Ramon y Cajal S, Pinango L, Barat A. Metastatic pure choriocarcinoma of the testis in an elderly man. J Urol. Mar 1987;137(3):516-9. [Medline].

  3. Berney DM, Warren AY, Verma M, Kudahetti S, Robson JM, Williams MW, et al. Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over. Mod Pathol. Jan 2008;21(1):54-9. [Medline].

  4. Batata MA, Whitmore WF Jr, Chu FC. Cryptorchidism and testicular cancer. J Urol. Sep 1980;124(3):382-7. [Medline].

  5. Klein EA. Tumor markers in testis cancer. Urol Clin North Am. Feb 1993;20(1):67-73. [Medline].

  6. Horstman WG. Scrotal imaging. Urol Clin North Am. Aug 1997;24(3):653-71. [Medline].

  7. Vugrin D, Cvitkovic E, Posner J. Neurological complications of malignant germ cell tumors of testis: biology of brain metastases (I). Cancer. Dec 1979;44(6):2349-53. [Medline].

  8. Bredael JJ, Vugrin D, Whitmore WF Jr. Autopsy findings in 154 patients with germ cell tumors of the testis. Cancer. Aug 1 1982;50(3):548-51. [Medline].

  9. Beahrs O, Henson D, Hutter R. Handbook for staging of cancer. In: The Manual of Staging Cancer. 4th ed. Philadelphia, Pa: JB Lippincott; 1993:195-7.

  10. Prow DM. Germ cell tumors: staging, prognosis, and outcome. Semin Urol Oncol. May 1998;16(2):82-93. [Medline].

  11. Logothetis CJSamuels MLSelig DEOgden SDexeus FSwanson DJohnson Dvon Eschenbach A. Cyclic chemotherapy with cyclophosphamide, doxorubicin, and cisplatin plus vinblastine and bleomycin in advanced germinal tumors. Results with 100 patients. American Journal of Medicine. 2/1986;81:219-28. [Medline].

  12. Tatokoro M, Kawakami S, Sakura M, Kobayashi T, Kihara K, Akamatsu H. Successful management of life-threatening choriocarcinoma syndrome with rupture of pulmonary metastatic foci causing hemorrhagic shock. Int J Urol. Mar 2008;15(3):263-4. [Medline].

  13. Bodiwala D, Summerton DJ, Terry TR. Testicular prostheses: development and modern usage. Ann Royal Coll Surg Engl. 2007;89:349-53. [Medline]. [Full Text].

  14. Mead GM. Chemotherapeutic Management of Metastatic Germ Cell Testis Cancer. Risk-Adapted Therapy/Poor Risk Patients. In: Vogelzang et al, eds. Comprehensive Textbook of Genitourinary Oncology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Williams; 2000:1024-31.

  15. Requena L, Sanchez M, Aguilar A. Choriocarcinoma of the testis metastatic to the skin. J Dermatol Surg Oncol. May 1991;17(5):466-70. [Medline].

  16. Saxman SB, Loehrer PJ. Chemotherapeutic Management of Metastatic Germ Cell Testicular Cancer. Overview of Initial Therapy for Metastatic Seminoma and Nonseminoma. In: Vogelzang et al, eds. Comprehensive Textbook of Genitourinary Oncology. 2000. 2nd ed. Philadelphia, Pa: Lippincott Williams & Williams; 1010-7.

  17. Batata MA, Chu FC, Hilaris BS. Therapy and prognosis of testicular carcinomas in relation to TNM classification. Int J Radiat Oncol Biol Phys. Aug 1982;8(8):1287-93. [Medline].

  18. Lepidini G, Biancari F, D'Andrea V. Severe thrombosis after chemotherapy for metastatic choriocarcinoma of the testis maintaining complete remission for a long period. Scand J Urol Nephrol. Apr 1997;31(2):221-2. [Medline].

  19. Bosl GJ, Geller N, Cirrincione C. Interrelationships of histopathology and other clinical variables in patients with germ cell tumors of the testis. Cancer. Jun 1 1983;51(11):2121-5. [Medline].

  20. Azzopardi JG, Mostofi FK, Theiss EA. Lesions of the testes observed in certain patients with widespread choriocarcinoma and related tumors. Am J Pathol. 1961;38:207-225.

  21. Fleming ID, Cooper JS, Henson DE, et al. AJCC Cancer Staging Manual. 5th ed. New York, NY: Lippincott-Raven; 1997.

  22. Kodama M, Murakami M, Kodama T. Chronological transition of the age-adjusted incidence rates (AAIRs) of 20 major neoplasias from early 1960s to mid-1980s. Anticancer Res. Jan-Feb 1999;19(1B):779-87. [Medline].

  23. Looijenga LH, Oosterhuis JW. Pathogenesis of testicular germ cell tumours. Rev Reprod. May 1999;4(2):90-100. [Medline].

  24. Parkin DM, Muir CS. Cancer Incidence in Five Continents. Comparability and quality of data. IARC Sci Publ. 1992;45-173. [Medline].

  25. Richie JP. Neoplasms of the Testis. In: Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders Co; 1998.

  26. Ro JY, Dexeus FH, el-Naggar A. Testicular germ cell tumors. Clinically relevant pathologic findings. Pathol Annu. 1991;26 Pt 2:59-87. [Medline].

  27. Swerdlow AJ. Epidemiology of testicular cancer. In: Principles and Practice of Genitourinary Oncology. Philadelphia, Pa: Lippincott-Raven Publishers; 1997.

  28. Ulbright TM. Germ cell neoplasms of the testis. Am J Surg Pathol. Nov 1993;17(11):1075-91. [Medline].

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Keywords

testicular choriocarcinoma, trophoblastic malignant teratoma, trophoblastic neoplasia, testicular seminoma, nonseminomatous germ cell tumors, NSGCT, germ cell tumors, GCT

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Contributor Information and Disclosures

Author

Michael B Williams, MD, MS, Fellow, Department of Urologic Oncology, MD Anderson Cancer Center
Disclosure: Nothing to disclose.

Coauthor(s)

Paul Schellhammer, MD, Chairman, Program Director, Professor, Department of Urology, Eastern Virginia Medical School
Paul Schellhammer, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

John W Davis, MD, Assistant Professor, Department of Urology, University of Texas MD Anderson Cancer Center
John W Davis, MD is a member of the following medical societies: American College of Surgeons and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Leonard Gabriel Gomella, MD, FACS, The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Thomas Jefferson University
Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology
Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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