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| Detailed Guide: Testicular Cancer |
What Happens After Treatment? |
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Completing treatment can be both stressful and exciting. You will be
relieved to finish treatment, yet it is hard not to worry about cancer
coming back. (When cancer returns, it is called recurrence.) This is a
very common concern among those who have had cancer.
It may take a while before your confidence in your own recovery begins
to feel real and your fears are somewhat relieved. Even with no
recurrences, people who have had cancer learn to live with uncertainty.
Follow-up Care
In no other cancer is follow-up care as important after treatment as in testicular cancer. 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 studies to detect 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 (see previous information above).
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. There is about a 3% chance that men who have had cancer in one testicle will develop a cancer in the other. Usually this is a new cancer and is not metastasis from the previous tumor. There is always an outside chance the cancer can come back, sometimes as long as 30 years later.
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 includes in vitro fertilization, in which an egg cell that has been removed from your partner’s ovary is returned to her uterus after it has been fertilized by your sperm cells in a laboratory dish. Be sure to discuss any fertility concerns with your doctor before your treatment begins.
Almost any cancer treatment has side effects. Some may last for a few weeks to several months, but others can be permanent. Don’t hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.
It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about is paying for treatment.
Seeing a New Doctor
At some point after your cancer diagnosis and treatment, you may find
yourself in the office of a new doctor. Your original doctor may have
moved or retired, or you may have moved or changed doctors for some
reason. It is important that you be able to give your new doctor the
exact details of your diagnosis and treatment. Make sure you have the
following information handy:
- a copy of your pathology report from any biopsy or surgery
- if you had surgery, a copy of your operative report
- if you were hospitalized, a copy of the discharge summary
that every doctor must prepare when patients are sent home from the
hospital
- finally, since some drugs can have long-term side effects,
a list of your drugs (especially chemotherapy drugs), drug doses, and when you took them
Lifestyle Changes to Consider During and After Treatment
Having cancer and dealing with treatment can be time-consuming and
emotionally draining, but it can also be a time to look at your life in
new ways. Maybe you are thinking about how to improve your health over
the long term. Some people even begin this process during cancer
treatment.
Make Healthier Choices
Think about your life before you learned you had cancer. Were there
things you did that might have made you less healthy? Maybe you drank
too much alcohol, or ate more than you needed, or smoked, or didn’t
exercise very often. Emotionally, maybe you kept your feelings bottled
up, or maybe you let stressful situations go on too long.
Now is not the time to feel guilty or to blame yourself. However, you
can start making changes today that can have positive effects for the
rest of your life. Not only will you feel better but you will also be
healthier. What better time than now to take advantage of the
motivation you have as a result of going through a life-changing
experience like having cancer?
You can start by working on those things that you feel most concerned
about. Get help with those that are harder for you. For instance, if
you are thinking about quitting smoking and need help, call the
American Cancer Society’s Quitline® tobacco cessation program at
1-800-ACS-2345.
Diet and Nutrition
Eating right can be a challenge for anyone, but it can get even tougher
during and after cancer treatment. For instance, treatment often may
change your sense of taste. Nausea can be a problem. You may lose your
appetite for a while and lose weight when you don’t want to. On the
other hand, some people gain weight even without eating more. This can
be frustrating, too.
If you are losing weight or have taste problems during treatment, do
the best you can with eating and remember that these problems usually
improve over time. You may want to ask your cancer team for a referral
to a dietitian, an expert in nutrition who can give you ideas on how to
fight some of the side effects of your treatment. You may also find it
helps to eat small portions every 2 to 3 hours until you feel better
and can go back to a more normal schedule.
One of the best things you can do after treatment is to put healthy
eating habits into place. You will be surprised at the long-term
benefits of some simple changes, like increasing the variety of healthy
foods you eat. Try to eat 5 or more servings of vegetables and fruits
each day. Choose whole grain foods instead of white flour and sugars.
Try to limit meats that are high in fat. Cut back on processed meats
like hot dogs, bologna, and bacon. Get rid of them altogether if you
can. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the
most. And don't forget to get some type of regular exercise. The
combination of a good diet and regular exercise will help you maintain
a healthy weight and keep you feeling more energetic.
Rest, Fatigue, Work, and Exercise
Fatigue is a very common symptom in people being treated for cancer.
This is often not an ordinary type of tiredness but a “bone-weary”
exhaustion that doesn’t get better with rest. For some, this fatigue
lasts a long time after treatment, and can discourage them from
physical activity.
However, exercise can actually help you reduce fatigue. Studies have
shown that patients who follow an exercise program tailored to their
personal needs feel physically and emotionally improved and can cope
better.
If you are ill and need to be on bed rest during treatment, it is
normal to expect your fitness, endurance, and muscle strength to
decline some. Physical therapy can help you maintain strength and range
of motion in your muscles, which can help fight fatigue and the sense
of depression that sometimes comes with feeling so tired.
Any program of physical activity should fit your own situation. An
older person who has never exercised will not be able to take on the
same amount of exercise as a 20-year-old who plays tennis 3 times a
week. If you haven’t exercised in a few years but can still get around,
you may want to think about taking short walks.
Talk with your health care team before starting, and get their opinion
about your exercise plans. Then, try to get an exercise buddy so that
you’re not doing it alone. Having family or friends involved when
starting a new exercise program can give you that extra boost of
support to keep you going when the push just isn’t there.
If you are very tired, though, you will need to balance activity with
rest. It is okay to rest when you need to. It is really hard for some
people to allow themselves to do that when they are used to working all
day or taking care of a household. (For more information about fatigue,
please see the publication, "Cancer
Related Fatigue and Anemia Treatment Guidelines for Patients."
Exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation)
fitness.
- It strengthens your muscles.
- It reduces fatigue.
- It lowers anxiety and depression.
- It makes you feel generally happier.
- It helps you feel better about yourself.
And long term, we know that exercise plays a role in preventing some
cancers. The American Cancer Society, in its guidelines on physical
activity for cancer prevention, recommends that adults take part in at
least 1 physical activity for 30 minutes or more on 5 days or more of
the week. Children and teens are encouraged to try for at least 60
minutes a day of energetic physical activity on at least 5 days a week.
How About Your Emotional Health?
Once your treatment ends, you may find yourself overwhelmed by
emotions. This happens to a lot of people. You may have been going
through so much during treatment that you could only focus on getting
through your treatment.
Now you may find that you think about the potential of your own death,
or the effect of your cancer on your family, friends, and career. You
may also begin to re-evaluate your relationship with your spouse or
partner. Unexpected issues may also cause concern -- for instance, as
you become healthier and have fewer doctor visits, you will see your
health care team less often. That can be a source of anxiety for some.
This is an ideal time to seek out emotional and social support. You
need people you can turn to for strength and comfort. Support can come
in many forms: family, friends, cancer support groups, church or
spiritual groups, online support communities, or individual counselors.
Almost everyone who has been through cancer can benefit from getting
some type of support. What's best for you depends on your situation and
personality. Some people feel safe in peer-support groups or education
groups. Others would rather talk in an informal setting, such as
church. Others may feel more at ease talking one-on-one with a trusted
friend or counselor. Whatever your source of strength or comfort, make
sure you have a place to go with your concerns.
The cancer journey can feel very lonely. It is not necessary or
realistic to go it all by yourself. And your friends and family may
feel shut out if you decide not include them. Let them in -- and let in
anyone else who you feel may help. If you aren’t sure who can help,
call your American Cancer Society at 1-800-ACS-2345 and we can put you
in touch with an appropriate group or resource.
You can’t change the fact that you have had cancer. What you can change
is how you live the rest of your life -- making healthy choices and
feeling as well as possible, physically and emotionally.
What Happens if Treatment Is No Longer Working?
If cancer continues to grow after one kind of treatment, or if it
returns, it is often possible to try another treatment plan that might
still cure the cancer, or at least shrink the tumors enough to help you
live longer and feel better. On the other hand, when a person has
received several different medical treatments and the cancer has not
been cured, over time the cancer tends to become resistant to all
treatment. At this time it’s important to weigh the possible limited
benefit of a new treatment against the possible downsides, including
continued doctor visits and treatment side effects.
Everyone has his or her own way of looking at this. Some people may
want to focus on remaining comfortable during their limited time left.
This is likely to be the most difficult time in your battle with cancer
-- when you have tried everything medically within reason and it’s just
not working anymore. Although your doctor may offer you new treatment,
you need to consider that at some point, continuing treatment is not
likely to improve your health or change your prognosis or
survival.
If you want to continue treatment to fight your cancer as long as you
can, you still need to consider the odds of more treatment having any
benefit. In many cases, your doctor can estimate the response rate for
the treatment you are considering. Some people are tempted to try more
chemotherapy or radiation, for example, even when their doctors say
that the odds of benefit are less than 1%. In this situation, you need
to think about and understand your reasons for choosing this plan.
No matter what you decide to do, it is important that you be as
comfortable as possible. Make sure you are asking for and getting
treatment for any symptoms you might have, such as pain. This type of
treatment is called “palliative” treatment.
Palliative treatment helps relieve these symptoms, but is not expected
to cure the disease; its main purpose is to improve your quality of
life. Sometimes, the treatments you get to control your symptoms are
similar to the treatments used to treat cancer. For example, radiation
therapy might be given to help relieve bone pain from bone metastasis.
Or chemotherapy might be given to help shrink a tumor and keep it from
causing a bowel obstruction. But this is not the same as receiving
treatment to try to cure the cancer.
At some point, you may benefit from hospice care. Most of the time,
this is given at home. Your cancer may be causing symptoms or
problems that need attention, and hospice focuses on your comfort. You
should know that receiving hospice care doesn’t mean you can’t have
treatment for the problems caused by your cancer or other health
conditions. It just means that the focus of your care is on living life
as fully as possible and feeling as well as you can at this difficult
stage of your cancer.
Remember also that maintaining hope is important. Your hope for a cure
may not be as bright, but there is still hope for good times with
family and friends -- times that are filled with happiness and meaning.
In a way, pausing at this time in your cancer treatment is an
opportunity to refocus on the most important things in your life. This
is the time to do some things you’ve always wanted to do and to stop
doing the things you no longer want to do.
Revised: 11/14/2007
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