Post-Orchiectomy Care Plan for Testicular Cancer
The post-orchiectomy follow-up for testicular cancer patients should include regular monitoring with serum tumor markers, physical examinations, and appropriate imaging studies based on cancer type and stage, with frequency decreasing over time. 1
Immediate Post-Operative Care (First 2-4 Weeks)
- Keep the incision site clean and dry, with gentle cleansing using mild soap and water 2
- Avoid strenuous physical activity and heavy lifting for 2-4 weeks after surgery 2
- Wear supportive underwear or scrotal support for comfort and to reduce swelling 2
- Monitor for signs of infection (redness, swelling, warmth, drainage, fever) 2
- Apply ice packs for 15-20 minutes at a time during the first 24-48 hours to reduce swelling 2
Follow-Up Schedule for Nonseminoma
First Year:
- Serum tumor markers (AFP, β-HCG, LDH) every 2 months 1
- Physical examination with chest radiograph every 2 months 1
- Abdominal/pelvic CT scan as clinically indicated (3-6 months post-surgery if RPLND was performed) 1
Second Year:
- Serum tumor markers every 3 months 1
- Physical examination with chest radiograph every 3 months 1
- Abdominal/pelvic CT scan as clinically indicated 1
Third and Fourth Years:
- Serum tumor markers every 6 months 1
- Physical examination with chest radiograph every 6 months 1
- Abdominal/pelvic CT scan as clinically indicated 1
Fifth through Tenth Years:
- Serum tumor markers annually 1
- Physical examination with chest radiograph annually 1
- Abdominal/pelvic CT scan as clinically indicated 1
Follow-Up Schedule for Seminoma
First Year:
- Serum tumor markers (AFP, β-HCG, LDH) every 2 months 1
- Physical examination with chest radiograph every 2 months 1
- Abdominal/pelvic CT scan as clinically indicated 1
Second Year:
- Serum tumor markers every 3 months 1
- Physical examination with chest radiograph every 3 months 1
- Abdominal/pelvic CT scan as clinically indicated 1
Third and Fourth Years:
- Serum tumor markers every 6 months 1
- Physical examination with chest radiograph every 6 months 1
- Abdominal/pelvic CT scan annually for the first 3 years 1
Fifth through Tenth Years:
- Serum tumor markers annually 1
- Physical examination with chest radiograph annually 1
- Abdominal/pelvic CT scan as clinically indicated 1
Additional Management Considerations
For Stage I Disease:
- For nonseminoma stage IA: Consider surveillance or nerve-sparing RPLND 1
- For nonseminoma stage IB: Consider nerve-sparing RPLND or adjuvant chemotherapy (2 cycles of BEP) 1
- For seminoma stage I: Surveillance is preferred over adjuvant radiotherapy or carboplatin-based chemotherapy 1
For Patients with Equivocal Imaging:
- Consider repeat imaging in 6-8 weeks to clarify disease extent before making treatment recommendations 1
Fertility Considerations:
- Discuss sperm banking before any therapeutic intervention that may compromise fertility 1, 3
- Sperm banking may be performed either before or after orchiectomy, but before adjuvant therapy 1
Important Monitoring Considerations
- PET scanning is not routinely recommended for patients with nonseminoma 1
- For patients who have undergone RPLND, an abdominal/pelvic CT scan is recommended between 3-6 months post-surgery 1
- Patients with persistently elevated serum markers post-orchiectomy (stage IS) should be treated with standard chemotherapy rather than RPLND 1
When to Seek Medical Attention
- Fever above 101°F (38.3°C) 2
- Increasing pain not controlled by prescribed pain medication 2
- Excessive bleeding or drainage from the incision site 2
- Significant swelling or bruising 2
- Signs of infection (redness, warmth, purulent drainage) 2
Common Pitfalls and Caveats
- Phantom sensations after orchiectomy occur in approximately 12% of patients and typically resolve within 18 months 4
- Scrotal violation during orchiectomy has historically been concerning, but evidence suggests it may not significantly worsen overall prognosis 5
- Late consequences of cisplatin-based chemotherapy should be monitored during long-term follow-up 1
- Recurrence after stage I seminoma rarely occurs after more than 3 years from treatment 1