Testicular Seminoma Follow-up

Updated: Mar 03, 2016
  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Follow-up

Further Inpatient Care

Most radical orchiectomies are performed in an outpatient setting, including 23-hour observation. This surgery is comparable to an inguinal herniorrhaphy, and the patient can expect limited physical activity for a brief period after surgery. A short course of pain management medication may be indicated postoperatively.

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Deterrence/Prevention

Males should begin monthly testicular self-examinations starting at puberty. Any abnormalities found should be reported to their physician.

After diagnosis of testicular GCT, the patient and treating physician should come to a mutual understanding regarding strict adherence to follow-up regimens to monitor for tumor recurrence.

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Prognosis

Mortality rates from testicular seminiomas increased until the 1970s but have since declined greatly as a result of advances in treatment. Currently, all stages have at least a 90% cure rate. [24]

Cure rates by stage are as follows:

  • Stage I: 98%-100%
  • Stage II (B1/B2 nonbulky): 98%-100%
  • Stage II (B3 bulky) and stage III: 90% complete response to chemotherapy and 86% durable response rate to chemotherapy.

Treatment-related disease in long-term survivors

Patients with testicular cancer are at an increased risk of secondary cancers because of their young age at diagnosis, high cure rate, and exposure to radiation, chemotherapy, or both. In a study of a cohort of 14 population-based tumor registries in Europe and North America totaling 40,576 patients, Travis et al reported that survivors of testicular cancer are at a significantly increased risk of solid tumors for at least 35 years after treatment. [27]

Tumors included malignant mesothelioma and those of the lung, colon, bladder, pancreas, and stomach. The relative risk increases were the same for seminoma and nonseminoma, and with treatment with radiation, chemotherapy, or both. For patients diagnosed with seminoma at age 35 years, the cumulative risk 40 years later was 36%, compared with 23% for the general population. [27]

Zagars et al reported on long-term follow-up involving 477 men with low-stage seminoma treated with orchiectomy and adjuvant radiation at a single institution. They compared long-term cancer-specific survival with cardiac-specific survival and performed a risk analysis in relation to standard US data for males. No differences were seen in the first 15 years, but, after 15 years, the relative risk of secondary cancer deaths was increased. [28]

In summary, these two long-term follow-up studies demonstrate that, although many men with seminoma are cured, they require counseling and long-term follow-up to minimize the risk of excess mortality from secondary cancers.

Increased risk for cardiac disease has also been observed in seminoma survivors. [27, 6] However, a population-based study in 9193 patients with stage I testicular seminoma by Beard et al found no increase in deaths from cardiovascular disease after radiotherapy. Deaths from second malignant neoplasms were elevated, but at a rate considerably lower than reported in historical series. [29]

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Patient Education

For patient education information, see the Men's Health Center and Cancer Center, as well as Testicular Cancer and Testicular Self-Exam.

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