Testicular Choriocarcinoma Follow-up

Updated: Apr 04, 2017
  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Follow-up

Further Outpatient Care

 As most cases of choriocarcinoma have poor risk features, primary chemotherapy is followed by radiographic reassessment and staging.

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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.

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Inpatient & Outpatient Medications

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

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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.

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Prognosis

In most reports, choriocarcinoma carries a dismal prognosis due to its early hematogenous spread. Examples are as follows:

  • Batata et al (1980) reported a 5-year survival rate of 0% (0 of 20 patients) [23]
  • 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 [21]
  • Lepidini et al (1997) reported a patient treated with multi-agent chemotherapy who was disease-free at 43 months of follow-up [24]
  • In five cases of pure choriocarcinoma with brain metastases, all patients died, and median survival was 1 month despite treatment with multi-agent chemotherapy [12]
  • 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 [25]
  • 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 [26]
  • 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]
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