What happens after treatment for testicular cancer?

For most people with testicular cancer, treatment removes or destroys the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. Our document called Living With Uncertainty: The Fear of Cancer Recurrence gives more detailed information on this.

For a few people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. Our document called When Cancer Doesn't Go Away talks more about this.

Follow-up care

When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.

Follow-up care is extremely important after treatment of testicular cancer because even if it comes back, it is still often curable. That is why finding it early is so important.

Your health care team will explain what tests you need and how often they should be done. You will need frequent blood tests to measure levels of certain protein markers (alpha-fetoprotein [AFP], human chorionic gonadotropin [HCG], and lactate dehydrogenase [LDH]) to help detect relapse as early as possible. You will also need frequent x-rays, CT scans, and other imaging tests to look for recurrence, metastasis, or a new tumor. After a few years these appointments and tests will not have to be done as often. Depending on the type of treatment that you have had, you may also need specific follow-up for the possible complications of treatment.

Make a special effort to keep all appointments with your cancer care team and follow their instructions carefully. Report any new or recurring symptoms to your doctor right away. Most of the time, if the cancer comes back, it does so in the first 5 years. Still, there is always an outside chance the cancer can come back later. There is also about a 3% chance that men who have had cancer in one testicle will develop a new cancer in the other testicle., so men who have had testicular cancer should report any changes to their remaining testicle to their doctor.

Most men develop cancer in only one testicle. The remaining testicle usually can make enough testosterone (the male hormone) to keep the man healthy. If the other testicle needs to be removed because a new cancer develops, that man will need to take some form of testosterone the rest of his life. Most often this is in the form of a gel or patch that is applied to the skin or a monthly injection (given in a doctor’s office). If you need testosterone supplements, talk to your doctor about what form is best for you.

Testicular cancer or its treatment can make a man infertile. Before treatment starts, men who wish to father children may want to consider storing sperm in a sperm bank for later use. Be aware, however, that the disease can cause low sperm counts, which may make it hard to obtain a good sample. In some cases, if one testicle remains, fertility returns temporarily or permanently after the testicular cancer has been treated successfully. For example, fertility typically returns 2 years after chemotherapy stops. Even when sperm counts in semen are very low, men have several options for fathering children. One of these options is in vitro fertilization, in which an egg cell that has been removed from your partner's ovary is fertilized by your sperm cells in a laboratory and then returned to her uterus. Be sure to discuss any fertility concerns with your doctor before your treatment begins.

It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

Should your cancer come back, our document called When Your Cancer Comes Back: Cancer Recurrence can give you information on how to manage and cope with this phase of your treatment.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself seeing a new doctor who does not know anything about your medical history. It is important that you be able to give your new doctor the details of your diagnosis and treatment. Make sure you have the following information handy:

• A copy of your pathology report(s) from any biopsies or surgeries
• If you had surgery, a copy of your operative report(s)
• If you were hospitalized, a copy of the discharge summary that doctors prepare when patients are sent home
• If you had radiation therapy, a copy of the treatment summary
• If you had chemotherapy or other medicines, a list of your drugs, drug doses, and when you took them
• Copies of your CT scans (or other imaging tests) – these can often be placed on a DVD

The doctor may want copies of this information for his records, but always keep copies for yourself.