title: Detection of second malignancies during long-term follow-up of testicular cancer survivors.
abstract: 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.
authors.affiliation: Department of Oncology and First Faculty of Medicine, Thomayer University Hospital and Charles University, Prague, Czech Republic. tomas.buchler@ftn.cz
authors.forename: Tomas
authors.initials: T
authors.lastname: Buchler
authors.forename: Petra
authors.initials: P
authors.lastname: Kubankova
authors.forename: Ludmila
authors.initials: L
authors.lastname: Boublikova
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Donatova
authors.forename: Martin
authors.initials: M
authors.lastname: Foldyna
authors.forename: Jana
authors.initials: J
authors.lastname: Kanakova
authors.forename: Drahomira
authors.initials: D
authors.lastname: Kordikova
authors.forename: Martin
authors.initials: M
authors.lastname: Kupec
authors.forename: Jana
authors.initials: J
authors.lastname: Nepomucka
authors.forename: Eva
authors.initials: E
authors.lastname: Vorsilkova
authors.forename: Jitka
authors.initials: J
authors.lastname: Abrahamova
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D010349:Patient Compliance; D012189:Retrospective Studies; D017741:Survivors; D013736:Testicular Neoplasms / Q000628:therapy*