The evidence-based recommendations described below outline the standard follow-up procedures for non-seminoma testicular cancer surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.
Once a patient has been discharged from Cancer Care Alberta, their primary care provider is asked to organize the following surveillance activities according to the schedule below:
Year of Follow-up
| 1 | 2 | 3 | 4-5 | |
|---|---|---|---|---|
| Stage I |
Every 2 months*: P/E, blood markers, CXR |
Every 3 months: P/E, blood markers, CXR |
Every 4 months: P/E, blood markers, CXR. CT as clinically indicated. |
Every 6 months: P/E, blood markers, CXR. CT as clinically indicated. CT abdo/pelvis at end of year 5. |
| Stage II |
Every 2 months: P/E, blood markers, CXR |
Every 3 months: P/E, blood markers, CXR |
Every 4 months: P/E, blood markers, CXR. CT as clinically indicated. |
Every 6 months: P/E, blood markers, CXR. CT as clinically indicated. CT abdo/pelvis at end of year 5 |
| Stage III |
Every 2 months: P/E, blood markers, CXR |
Every 3 months: P/E, blood markers, CXR |
Every 4 months: P/E, blood markers, CXR. CT as clinically indicated. |
Every 6 months: P/E, blood markers, CXR. CT as clinically indicated. CT chest/abdo/pelvis at end of year 5. |
P/E: physical exam
CXR: chest x-ray
Blood markers: alpha-fetoprotein (αFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH)
Hormone levels: LH (Luteinizing hormone), FSH (Follicular stimulating hormone), total testosterone
*For patients at higher risk of relapse (lymphovascular invasion, rete testis invasion, or embryonal subtype), measure markers every month in year 1.
Physical exam should include close examination of abdomen, contralateral testicle, and cervical and supraclavicular nodes. Due to the risk of late effects of chemotherapy, cardiovascular, pulmonary, or neurologic symptoms should be evaluated thoroughly.
PDF templates for surveillance activities & timelines can be found in the Non-Seminoma Testicular Cancer Transfer of Care Physician letter.
For patients presenting with any symptoms or signs of recurrence, such as elevated tumour markers or concerning imaging, re-referral to the cancer centre is required. Contact the GU Triage Coordinator at: Tom Baker Cancer Centre/Southern Alberta, 403-521-3148 or Cross Cancer Institute/Northern Alberta, 780-432-8134. If you are unable to reach the triage coordinator, search "cancer" in the Alberta Referral Directory for the most up-to-date information and instructions for referral.
If your patient received chemotherapy, potential chemotherapy-related side effects including peripheral neuropathy, pulmonary toxicity, ototoxicity, and Raynaud-like phenomena can occur.
Both radiation and chemotherapy may slightly increase the risk of cardiovascular disease and the development of secondary cancers, so monitoring of hypertension, dyslipidemia, and body mass index, as well as smoking cessation counselling, is important. Patients should be encouraged to report any unusual symptoms promptly.
Long-term orchidectomy side effects are usually minimal. However, in the rare circumstance where both testicles were removed, side effects may include erectile dysfunction and testosterone deficiency.
Testicular cancer survivors may have significant adjustment issues, anxiety and/or depression, self-image concerns, addiction issues, and issues related to employment and finances. A referral to psychosocial oncology may be beneficial. Refer to patient support for available resources.
Fertility & Sexuality
Treatment for testicular cancer can have significant effects on fertility and sexual function. Psychosocial issues surrounding a cancer diagnosis and treatment may decrease libido in some patients and a referral to psychosocial oncology may be beneficial.
For men who underwent unilateral orchidectomy, the remaining testicle usually produces sufficient testosterone. Some men may experience decreased libido, but this usually improves with time. A testicular prosthesis may improve confidence and body image.
Some men may develop hypogonadism requiring testosterone supplementation, and those who had bilateral orchidectomy will require supplementation. Patients who underwent retroperitoneal lymph node dissection may have nerve damage leading to retrograde ejaculation.
Fertility will likely be reduced in most men who had chemotherapy. This may change and improve over time. A referral to a fertility specialist can be considered if there are concerns. Most patients who have treatment that could reduce fertility will have been offered sperm banking as an option. However, there are significant costs associated with sperm banking. Most of the sexual and fertility side effects of testicular cancer treatment are temporary, but appropriate referrals could improve patient quality of life.
More information about fertility and sexuality is found in the Non-seminoma Testicular Cancer Transfer of Care Physician Letter.
Note: The information on this page was adapted from the AHS Guideline Resource Unit's Testicular Germ Cell Tumours Guideline, and the accompanying Non-seminoma Testicular Cancer Transfer of Care Physician Letter. Also available is the Non-seminoma Testicular Cancer Transfer of Care Patient Letter.
