ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.
Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.
Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. People who had testicular cancer usually receive follow-up screening for at least 10 years after their treatment ends.
For people with non-seminoma and advanced seminoma, it is important that follow-up care includes testing of tumor marker levels. Increases in the tumor marker levels are often the first sign that the cancer has returned. ASCO recommends the following schedule for testing tumor marker levels:
Non-seminoma. Alpha-fetoprotein (AFP) and beta human chorionic gonadotropin (beta-hCG) should be measured at regular times. ASCO recommends the following schedule:
Year 1. Every 1 to 2 months.
Year 2. Every 2 to 4 months.
Years 3 and 4. Every 3 to 6 months.
Year 5. Every 6 months.
Years 6 to 10. Once a year.
Advanced seminoma. ASCO recommends only checking tumor marker levels for advanced seminoma using the following schedule:
Year 1. Every 2 to 4 months.
Year 2. Every 3 to 4 months.
Years 3 and 4. Every 4 to 6 months.
Years 5 to 10. Once a year.
However, even after this specific follow-up period ends, people should let any doctor treating them know that they have a history of testicular cancer. This includes your general or primary care doctor, who can then monitor for possible long-term side effects throughout your lifetime.
Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.
Learn more about the importance of follow-up care.
Watching for recurrence
One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.
The anticipation before having a follow-up test of waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.
Managing long-term side effects
Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.
Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.
Below are some of the long-term side effects that are possible after treatment for testicular cancer.
Lung problems. Nine doses of bleomycin can cause lung damage for about 5% of patients and is fatal for less than 1% of patients receiving the drug. Lung scarring is another possible long-term side effect. The risk factors for lung scarring are being older than 70, smoking tobacco or other drugs, previous lung injury, previous radiation therapy to the chest, poor kidney function, or receiving additional doses of bleomycin. It is rare to have lung effects without any of these risk factors. Therefore, if someone has these risk factors and good-risk disease, 4 cycles of EP chemotherapy can be used instead of 3 cycles of BEP chemotherapy. If 4 cycles of chemotherapy are needed, ifosfamide can be used instead of bleomycin, but it is linked with more short-term side effects, such as infections.
Bleomycin also makes the lungs more sensitive, and patients who need to receive extra oxygen during surgery may have a higher risk of lung damage from bleomycin.
Important issues are:
Patients who smoke should stop smoking for many health reasons, but in particular to reduce the risk of lung damage from bleomycin.
The doctor should examine the patient’s lungs before each cycle of chemotherapy and stop bleomycin treatment if lung damage is seen.
Kidney damage. Cisplatin can cause kidney damage. However, it is a very important drug to treat testicular cancer. Also, cisplatin has fewer side effects than carboplatin, which has also been shown to be less effective. The best way to prevent this problem is for cisplatin to be flushed out by giving the patient at least 1 liter of IV fluid before and after the drug is given. This reduces the risk of kidney damage. Research studies looking at kidney function years after receiving cisplatin have shown low rates of long-term kidney damage and when it does occur, it is generally mild.
Heart and blood vessel problems. A condition called Raynaud’s phenomenon may be caused by bleomycin. This condition is associated with narrowing blood vessels and changes in skin color, such as becoming pale, then blue, and then red when exposed to certain triggers, such as cold. This is especially common in the hands. Less than 10% of patients develop Raynaud’s phenomenon. More people develop this condition when vinblastine and bleomycin are combined, but this regimen is almost never used now. Avoiding the triggers, such as preventing the fingers from becoming cold, is the main treatment.
People who receive BEP chemotherapy may have higher cholesterol and blood pressure levels and an increased risk of heart disease and/or stroke. Radiation therapy has also been associated with an increased risk of heart disease. The increased risk is small and outweighed by the fact that it is necessary to treat the cancer. However, these side effects are more important when the doctor considers chemotherapy or radiation therapy to prevent the cancer from coming back for people with clinical stage I disease. A healthy diet, exercise, not smoking, and medications to lower cholesterol, control high blood pressure, or treat diabetes are ways to reduce the risk of heart disease and stroke. Learn more about heart problems.
Nerve damage. Cisplatin can sometimes damage the nerves, causing feelings of numbness or “pins and needles.” When this occurs, it most often starts during the chemotherapy and lessens and goes away with time. It may take months or even years to completely go away. Rarely, it can affect a person’s function, such as making it difficult to button a shirt. Learn more about nerve problems or neuropathy.
Hearing problems. Sometimes, people who received cisplatin may notice that they can no longer hear high-pitch sounds. This is more common with higher doses, and it is more likely for older adults or those with previous hearing problems. It rarely affects young people but may be relevant for musicians or others who depend on having very fine hearing abilities. Another hearing-related side effect of cisplatin may be tinnitus, which is ringing in the ears. Learn more about hearing problems.
Second cancers. People who receive chemotherapy and/or radiation therapy for testicular cancer have an increased risk of developing other types of cancer in the future. The thought of developing another cancer can be concerning and difficult to face. However, if the testicular cancer has metastasized (stage II or III), then the cancer needs to be treated effectively. Chemotherapy and radiation therapy often play important roles in treating testicular cancer when the goal is to cure the disease. Even though they pose some risk, chemotherapy and radiation therapy are sometimes the best options for controlling cancer growth and lengthening your life. The issue of second cancers may be particularly important for people with stage I disease and early stage II disease that can be cured with surgery alone. In such cases, patients may have a choice between surgery alone versus surgery plus chemotherapy or radiation therapy. Talk with your doctor about the role of chemotherapy and radiation therapy in your treatment, including why it is recommended and what the risks and benefits are. Learn more about second cancers.
Fertility. The issue of fertility in people with testicular cancer is a complex topic because patients with testicular cancer often have a lower sperm count even before any treatment is given. Someone who has fertility problems after treatment should talk with their doctor about these factors:
Sperm count before chemotherapy
Whether chemotherapy or radiation therapy was given previously
How long ago the treatment was given
Whether an experienced surgeon performed a nerve-sparing RPLND to preserve ejaculation
A low sperm count does not necessarily mean that a person will be infertile after treatment because most patients will develop very low to no sperm counts while receiving chemotherapy. The chance of fertility returning after treatment increases over time, but it is lower for those with no or low sperm counts before chemotherapy. It is also important to ask about fertility preservation, including sperm banking, before treatment.
Low testosterone. In addition to damage to the ability to make sperm, the cells that make testosterone may be damaged. If there is a low testosterone level, then hormone replacement therapy can be used. As outlined in Types of Treatment, symptoms of a reduced testosterone level include decreased sex drive, inability to achieve a normal penile erection and orgasm, fatigue, hot flashes, depression, mood changes, muscle and bone loss, as well as metabolic syndrome. Metabolic syndrome is a set of conditions, including obesity, high levels of blood cholesterol, and high blood pressure, that increases a person’s risk of heart disease, stroke, and diabetes.
Keeping personal health records
You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.
This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.
If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.
The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.