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Testicular Choriocarcinoma Follow-up

  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
Updated: Apr 16, 2015

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)[21]
  • 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[19]
  • Lepidini et al (1997) reported a patient treated with multi-agent chemotherapy who was disease-free at 43 months of follow-up[22]
  • In five cases of pure choriocarcinoma with brain metastases, all patients died, and median survival was 1 month despite treatment with multi-agent chemotherapy[11]
  • 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[23]
  • 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[24]
  • 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[4]
Contributor Information and Disclosures

Michael B Williams, MD, MS Assistant Professor, Department of Urology, Leroy T Canoles, Jr, Cancer Research Center, Eastern Virginia Medical School

Michael B Williams, MD, MS is a member of the following medical societies: American Association for Cancer Research, American Urological Association, Society of Urologic Oncology, Texas Medical Association, American Society of Clinical Oncology, American Association of Clinical Urologists

Disclosure: Nothing to disclose.


Paul F Schellhammer, MD Professor of Urology, Eastern Virginia Medical School; Urologist, Urology of Virginia, PC

Paul F Schellhammer, MD is a member of the following medical societies: American Medical Association, American Urological Association, Society of Surgical Oncology, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Jefferson Medical College of 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, Society of Urologic Oncology

Disclosure: Received consulting fee from GSK for consulting; Received honoraria from Astra Zeneca for speaking and teaching; Received consulting fee from Watson Pharmaceuticals for consulting.


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.

Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer 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: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

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Testicular choriocarcinoma has multinucleated syncytiotrophoblastic cells that drape over smaller cytotrophoblastic cells, which together appear to form a border along a blood-filled villouslike space (upper right). Used with permission from Ernstoff MS, Heaney JA, and Peschel RE, eds. Testicular and Penile Cancer. Malden, Mass: Blackwell Science, Inc; 1998:20.
Table 1. Serum Tumor Markers (S)
SxNot assessedNot assessedNot assessed
S1< 1.5 x Nand< 5000and< 1000
S21.5-10 x Nor5000-50,000or1000-10,000
S3>10 x Nor>50,000or>10,000
*N=upper limit of reference range for the LDH assay
Table 2. Stage Grouping
Stage groupingTNMS
Stage 0pTisN0M0S0
Stage IT1-T4N0M0Sx
Stage IAT1N0M0S0
Stage IBT2-4N0M0S0
Stage ISAny TN0M0S1-S3
Stage IIAny TAny NM0Sx
Stage IIAAny TN1M0S0-S1
Stage IIBAny TN2M0S0-S1
Stage IICAny TN3M0S0-S1
Stage IIIAny TAny NM1Sx
Stage IIIAAny TAny NM1aS0-S1
Stage IIIBAny TAny NM0-M1aS2
Stage IIICAny TAny NM0-M1aS3
Any TAny NM1bAny S
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