Detection of second malignancies during long‐term follow‐up of testicular cancer survivors

• Published in: Cancer 2011-09, Vol.117 (18), p.4212-4218
• Main Authors: Buchler, Tomas, Kubankova, Petra, Boublikova, Ludmila, Donatova, Zuzana, Foldyna, Martin, Kanakova, Jana, Kordikova, Drahomira, Kupec, Martin, Nepomucka, Jana, Vorsilkova, Eva, Abrahamova, Jitka
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; diagnosis; Follow-Up Studies; follow‐up; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasms, Second Primary - diagnosis; Neoplasms, Second Primary - mortality; Neoplasms, Second Primary - pathology; outcome; Patient Compliance; Retrospective Studies; second malignancy; Survivors; testicular cancer; Testicular Neoplasms - therapy; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.26039

BACKGROUND: Second cancers are an important cause of mortality and morbidity in long‐term survivors of testicular germ cell tumors (TGCTs). Studies on the impact of follow‐up for the first tumor on the outcome of second malignancies are lacking. The aim of this study was to study the details of diagnosis of second cancers and the role of focused oncology follow‐up. METHODS: Medical records and the electronic database of a tertiary referral center for germ cell neoplasms were searched for second cancers diagnosed in TGCT survivors. In a database of 1057 patients, 63 cases of metachronous second malignancies (26 contralateral testicular cancers and 37 nontesticular cancers) were found in 57 patients. Long‐term oncology follow‐up consisted of yearly history, physical examination, germ cell tumor markers, and imaging including abdominal computed tomography (CT) scans and chest x‐ray. RESULTS: The second malignancies occurred after a medium follow‐up of 9.9 years (range, 1.1‐33 years) after the diagnosis of the first tumor. Only 17 (27%) of the 63 second tumors were detected by oncology follow‐up investigations, and a further 12 (29%) were detected by nononcology physicians during a preplanned clinical visit. In 34 (54%) cases, patients themselves or their relatives initiated a clinical appointment because of symptoms. Follow‐up investigations all had low yields for the detection of second malignancies, although CT imaging did detect several cases of cancer at an early stage. CONCLUSIONS: In this retrospective study, most second cancers occurring in long‐term TGCT survivors were missed by regular oncology follow‐up that included yearly physical examination, tumor marker, and imaging. Cancer 2011;. © 2011 American Cancer Society. Second cancers cause significant morbidity and mortality in testicular cancer survivors, but strategies for their early detection remain poorly defined. The authors describe the circumstances of diagnosis of second cancers in testicular cancer survivors. In their retrospective study, most cases of second cancers were missed using follow‐up that included yearly history, physical examination, tumor markers, and imaging.