title: Clinical examination does not assist in the detection of systemic relapse of testicular germ cell tumour.
abstract: OBJECTIVE
  Patients on follow-up after orchidectomy or chemotherapy for testicular germ cell tumours follow a protocol of outpatient appointments and investigations designed to detect relapse. We wanted to investigate the contribution of clinical examination to patient management.
  
  
  METHODS
  The notes of 70 consecutive patients who suffered a first systemic relapse of their germ cell tumour within the last 10 years were studied to determine how the relapse was detected. Second testicular tumours were excluded.
  
  
  RESULTS
  Of the 69 patients whose notes were available, only one had a significant finding on physical examination, concurrent with abnormal markers.
  
  
  CONCLUSIONS
  We suggest that, for patients following a planned programme of appointments and investigations, physical examination rarely contributes to the detection of systemic relapse in the follow-up of testicular germ cell tumours. It may therefore be possible to reconfigure follow-up to focus on investigations and telephone contact. We estimate that this change might be appropriate for 40% of attendances and might be welcomed by patients, many of whom find follow-up burdensome. If such a change were considered, patient education would be essential to ensure continuing compliance with the follow-up protocol.
authors: School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK. ngc26@cam.ac.uk
authors: N G
authors: NG
authors: Cunniffe
authors: J
authors: J
authors: Robson
authors: D
authors: D
authors: Mazhar
authors: M V
authors: MV
authors: Williams
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000628:therapy; D009919:Orchiectomy; D010808:Physical Examination; D011878:Radiotherapy; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents