Updated 18 August 2009

Following the completion of treatment, all patients need to be monitored for potential recurrence of cancer and complications of therapy. This is needed both for management of the individual patient (where early detection would improve outcome), and to permit periodic review and improvement of current treatment policy.

Often it is felt appropriate to share follow up with the family doctor (and/or the urologist), in which case it is important for the patient to be clear who is responsible for certain aspects of the disease, e.g. symptom control by the family doctor, with advice from the BC Cancer Agency at the doctor's request.

Notification is requested in the event of any of the following:

• Local recurrence at the primary site (particularly in patients with clinically localized disease treated with surgery and/or radiotherapy)
• Metastasis at regional or distant sites
• Complications of therapy, especially if acute requiring hospitalization, or chronic and symptomatic
• Death with primary cause and whether cancer or treatment contributed

The event, date, and evidence, where appropriate, should be sent to the Agency chart where it will come to the attention of the oncologist, and will be available for periodic review by the tumour group. This information is requested annually for patients no longer followed at the BC Cancer Agency.

Germ Cell Tumours

The BC Cancer Agency chooses to particularly follow:

Patients with useful future treatment options (most testis tumours), especially if the relapse is difficult to detect and/or timing of treatment is important.

At each visit patients require, as a minimum, history and physical examination, plus the investigations outlined in the schedule below. All patients require annual blood pressure measurement. Post-chemotherapy patients will require annual creatinine, Mg. Sperm counts may be measured at the patient's or physician's request and if necessary, related investigations may need pursuing.

The following guidelines are recommendations which may have to be adjusted in selected patients based upon the individual clinical situation.

*Low risk: tumour size <4 cm and no rete testis invasion

**High risk: either tumour >4 cm or rete testis invasion

*the CT of the pelvis can be omitted in patients who have not had scrotal or pelvic surgery that could alter the normal lymphatic drainage of the testicles.

Reference:

Rustin, G. J., G. M. Mead, et al. (2007). "Randomized trial of two or five computed tomography scans in the surveillance of patients with stage I nonseminomatous germ cell tumors of the testis: Medical Research Council Trial TE08, ISRCTN56475197--the National Cancer Research Institute Testis Cancer Clinical Studies Group." Journal of clinical oncology 25(11): 1310-5.

* depending on the presence of intrathoracic disease

Long Term Follow-Up

Follow-up after five years should be done once a year and can be done by the family doctor. The follow-up program should include the following: tumour marker AFP and HCG; examination of the remaining testicle; monitoring for potential cardiac risk factors (e.g. cholesterol, triglycerides, hypertension, microalbumenia etc).

References:

1. Meinardi MT, Gietema JA, van der Graaf WT, et al: Cardiovascular morbidity in long-term survivors of metastatic testicular cancer. J Clin Oncol 18:1725-1732, 2000
2. Strumberg D, Bruegge S, Korn MW, et al: Evaluation of long-term toxicity in patients after cisplatin-based chemotherapy for non-seminomatous testicular cancer. Ann Oncol 13:229-236, 2002

Non-Germ Cell Tumours

A definitive follow up program cannot be specified. Most Sertoli cell tumours with metastatic potential will relapse within six months of diagnosis. The pattern of relapse is similar to nonseminomatous germ cell tumours. It is suggested these patients be followed for a minimum of two years. Urinary or serum androgens and estrogen assays can be helpful.