Testicular Choriocarcinoma Follow-up
- Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS more...
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.
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.
Inpatient & Outpatient Medications
Following orchiectomy, a short course of pain management medication may be required.
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.
In most reports, choriocarcinoma carries a dismal prognosis. Examples are as follows:
- Batata et al (1980) reported a 5-year survival rate of 0% (0 of 20 patients)
- 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
- Lepidini et al (1997) reported a patient treated with multi-agent chemotherapy who was disease-free at 43 months of follow-up
- In five cases of pure choriocarcinoma with brain metastases, all patients died, and median survival was 1 month despite treatment with multi-agent chemotherapy
- In a 9-year review of patients treated in multi-agent chemotherapy trials at Memorial Sloan-Kettering Cancer Center, Bosl et al (1983) reported five cases of pure choriocarcinoma and two long-term survivors
- A review of survival after a diagnosis of testicular germ cell cancers in Germany and the United States from 2002-2006 found that 5-year relative survival was lowest with choriocarcinomas: 80.1% in Germany and 79.6% in the US; this compared with survival rates of 93.3% and 91.0% with nonseminomas generally
- A review by Alvarado-Cabrero et al (2014) found that of six patients with pure testicular choriocarcinoma, all died of their disease after a median of 9.5 months; of eight patients with predominant choriocarcinoma, five died of the disease after a median of 27 months, one was alive with disease, and two were alive with no evidence of disease at 60 and 72 months of follow-up, respectively; the latter two patients were the only ones with M1a disease on presentation
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|S||LDH||HCG (mIU/mL)||AFP (ng/mL)|
|Sx||Not assessed||Not assessed||Not assessed|
|S1||< 1.5 x N||and||< 5000||and||< 1000|
|S2||1.5-10 x N||or||5000-50,000||or||1000-10,000|
|S3||>10 x N||or||>50,000||or||>10,000|
|*N=upper limit of reference range for the LDH assay|
|Stage IS||Any T||N0||M0||S1-S3|
|Stage II||Any T||Any N||M0||Sx|
|Stage IIA||Any T||N1||M0||S0-S1|
|Stage IIB||Any T||N2||M0||S0-S1|
|Stage IIC||Any T||N3||M0||S0-S1|
|Stage III||Any T||Any N||M1||Sx|
|Stage IIIA||Any T||Any N||M1a||S0-S1|
|Stage IIIB||Any T||Any N||M0-M1a||S2|
|Stage IIIC||Any T||Any N||M0-M1a||S3|
|…||Any T||Any N||M1b||Any S|