Testicular cancer, while a serious diagnosis, has a high rate of successful treatment, particularly when identified early. Many individuals who undergo treatment achieve remission, but a common concern is the possibility of the cancer returning. Understanding recurrence helps individuals feel informed about their long-term health. This article explains what recurrence means and how it is managed.
Understanding Recurrence
Testicular cancer can return, known as recurrence, even after initial successful treatment. While not common, it remains a possibility for a small percentage of individuals. Most recurrences happen within the first two years following initial treatment, with less than 5% occurring beyond this window. Even if cancer reappears, effective treatments are available, and a cure is often still achievable.
Recurrence signifies that cancer cells, not eliminated by the first treatment, have regrown and become detectable. These returning cancer cells might appear in the same general area, though local recurrence in the scrotum is rare since the affected testicle is removed. More frequently, recurrence occurs in regional lymph nodes, especially those in the retroperitoneum (the area behind the abdominal organs), accounting for 50% to 80% of relapses. Other common sites include the lungs and, less frequently, the liver or distant lymph nodes like those above the collarbone.
Factors Influencing Recurrence
Several characteristics of the original cancer and its initial management influence recurrence likelihood. The specific type of testicular cancer plays a role; seminomas have a lower recurrence risk than non-seminomatous germ cell tumors. For instance, clinical stage I seminoma has a relapse risk of about 12-20% within five years after orchiectomy alone. Non-seminoma tumors may have a relapse risk of up to 30% in clinical stage I, with some studies indicating higher rates in specific high-risk groups.
The cancer’s stage at diagnosis also affects recurrence risk. More advanced cancers or those that spread beyond the testicle at initial diagnosis may have a higher chance of recurrence. Lymphovascular invasion, where cancer cells are found in small blood or lymphatic vessels within the tumor, significantly increases relapse risk for non-seminomatous tumors, potentially raising the recurrence rate to 50%. Elevated tumor markers like alpha-fetoprotein (AFP) or human chorionic gonadotropin (HCG) at diagnosis can indicate a higher recurrence risk or signal relapse if they rise after treatment.
The treatment approach chosen after initial surgery can further impact recurrence rates. For some early-stage cancers, surveillance (close monitoring) is an option. For those with higher risk features, adjuvant chemotherapy (chemotherapy after surgery) can substantially reduce recurrence.
Monitoring for Recurrence
Regular monitoring is important after initial testicular cancer treatment to detect recurrence early. Surveillance involves methods tailored to the individual’s cancer type, stage, and initial treatment. Physical examinations check for new lumps or swelling.
Blood tests measure tumor markers like AFP, HCG, and lactate dehydrogenase (LDH). A rise in these markers can be an early indicator that the cancer has returned, even before it is visible on imaging scans. Imaging studies, such as computed tomography (CT) scans of the abdomen, pelvis, and chest, visualize internal organs and lymph nodes where recurrence is most likely. In some cases, magnetic resonance imaging (MRI) or chest X-rays may also be used.
The frequency of these follow-up appointments and tests is highest in the first one to two years after treatment, when recurrence is most probable. For instance, physical exams and blood tests might be scheduled every three to six months initially, with imaging scans every three to six months. The schedule gradually becomes less frequent over several years, reflecting the decreasing risk of recurrence over time.
Treating Recurrent Testicular Cancer
Should testicular cancer recur, a personalized treatment plan is developed, taking into account the specific type of cancer, recurrence location and extent, and any previous treatments received. The aim of treatment for recurrent disease remains curative for many individuals. Chemotherapy is a primary treatment option, often involving multi-drug regimens like BEP (bleomycin, etoposide, cisplatin) or VIP (etoposide, ifosfamide, cisplatin), which may differ from initial chemotherapy.
Surgery is another treatment for recurrent testicular cancer, particularly if localized to areas like the retroperitoneal lymph nodes. A procedure known as retroperitoneal lymph node dissection (RPLND) may be performed to remove these affected nodes. In some situations, surgery might be considered even after chemotherapy, or occasionally, as a first step depending on the nature of the relapse.
Radiation therapy may be used for recurrent seminoma, particularly if the recurrence is confined to lymph nodes, as seminoma cells are sensitive to radiation. For more complex or widespread recurrences, high-dose chemotherapy followed by a stem cell transplant might be considered. A team of specialists collaboratively selects treatments to ensure the most effective approach for each individual’s situation.