title: Appropriateness of testicular cancer management: a population-based cohort study.
abstract: OBJECTIVE
  Testicular cancer is a highly curable malignancy of young men. Appropriate and timely management is critical to ensure optimal clinical outcomes. A 3-year population-based review of testicular cancer patients in Manitoba, Canada was undertaken to evaluate our management patterns.
  
  
  METHODS
  Men diagnosed with testicular cancer from 1998 to 2000 were identified from the Provincial Cancer Registry. Chart review was utilized to collect information on demographic characteristics, timelines of diagnostic and staging investigations, completeness of pathology reports, management, and outcomes.
  
  
  RESULTS
  Seventy-eight men were identified with 80 testicular cancers: 46 (59%) patients had 48 seminomas and 32 (41%) had non-seminomatous germ cell tumors (NSGCT). One or more pre-operative tumor markers were missing or unavailable in 41 (52%) cases. Median time from scrotal ultrasound to orchiectomy was 7 days, but was greater than 2 weeks in 13 (16%) patients. Pathology reports provided acceptable detail in only 21 (27%) cases. Eighteen subjects (23%) did not complete necessary staging investigations (chest and abdominal imaging, and post-orchiectomy markers) until at least 3 weeks after surgery. Post-orchiectomy management of both seminoma and NSGCT patients was largely within acceptable limits apart from some non-standard chemotherapy choices in advanced stage disease, and significant departures from standard recommendations regarding surveillance. The Kaplan-Meier estimate of overall survival at 5 years is 97% in seminoma and 84% in NSGCT.
  
  
  CONCLUSIONS
  Although clinical outcomes do not appear to have been compromised, deficiencies are evident in testicular cancer management in Manitoba from 1998 to 2000, indicating the need for well-defined management guidelines and improved education of caregivers.
authors.affiliation: Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Winson Y
authors.initials: WY
authors.lastname: Cheung
authors.forename: Alain
authors.initials: A
authors.lastname: Demers
authors.forename: Deloar
authors.initials: D
authors.lastname: Hossain
authors.forename: Tim
authors.initials: T
authors.lastname: Owen
authors.forename: Shahida
authors.initials: S
authors.lastname: Ahmed
authors.forename: Piotr M
authors.initials: PM
authors.lastname: Czaykowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009919:Orchiectomy; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor