If your testicular cancer comes back

When testicular cancer comes back it is called a relapse or recurrence. The aim of treatment is to cure your cancer. Treatment can usually still cure your cancer, even if it has spread to another part of your body.

If your cancer does come back within 2 years of finishing your treatment. This is known as early relapse.

 A late relapse is when the cancer comes back more than 2 years after your first treatment. This doesn't happen very often. Only around 2 or 3 out of 100 people with testicular cancer (around 2 to 3%) have a late relapse. 

Deciding about treatment

A team of specialist doctors will discuss your treatment plan. They will consider several factors including:

• your type of testicular cancer
• where the cancer is in your body
• your tumour marker levels
• how long it is since you finished treatment
• what treatment you had before and how well it worked
• your general health and fitness

Your doctor will discuss your options with you. They will tell you about the different treatment side effects. They will also discuss what treatment involves. For example, how long you have it and how often you will need to go to the hospital. 

What treatment will I have if my cancer comes back?

You usually have further treatment when your cancer comes back. The next treatment you have is called second line treatment.

Chemotherapy is a common second line treatment for recurrent testicular cancer. You might have surgery or radiotherapy depending on your situation.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate around your body in the bloodstream. 

You might have a different combination of chemotherapy drugs to your first treatment. Common second line chemotherapy drugs include:

• etoposide, ifosfamide, cisplatin (VIP)
• paclitaxel (Taxol), ifosfamide, cisplatin) (TIP)

Your doctor might recommend high dose chemotherapy with a stem cell transplant. They will give you more information if you have this treatment. 

Surgery

Surgery to treat testicular cancer that has come back depends on where it is and the type of cancer. Your doctor also looks at your blood tumour markers.

You might have surgery to remove lymph nodes in your tummy (retroperitoneal lymph node dissection). And the cancer has not spread to other parts of the body.

If you need to have surgery, you usually have the operation after chemotherapy.

In some situations, you might have an operation first when you relapse. This is more likely if:

• your doctors want to find out more about your type of cancer. Or you might have a biopsy of the area instead if the cancer cannot be removed completely  
• your non seminoma cancer has come back more than 2 years after treatment and the surgeon can remove it. You may have chemotherapy afterwards 

If your seminoma cancer comes back more than 2 years after treatment, you might have chemotherapy rather than surgery. 

Radiotherapy

You might have radiotherapy in certain situations. This might be when seminoma cancer has come back or has spread to other parts of the body. Your doctor will let you know whether this treatment is suitable for you.

After first relapse

When testicular cancer comes back again, it is called a second relapse, third relapse, and so on.

You might have one of the other treatment options above. If you have had second line chemotherapy before, you might have third line chemotherapy using the drugs gemcitabine and oxaliplatin.

Or you might have other drugs as part of a clinical trial .

Clinical trials

Your doctor may ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to:

• improve treatment
• reduce the side effects of treatment
• develop new treatments

Coping with relapse

It can be a big shock hearing that your cancer has come back. It can be difficult having to face treatment again. You may be coping with a range of feelings such as frustration and fear. 

You might need further tests to find out where the cancer is in your body. This will help your doctors decide what your treatment options are.

Your doctor and specialist nurse will talk to you about your test results and tell you about your treatment options and what they involve. They will explain more about the aim of treatment, and help you make decisions about your treatment.

The type of support people need also varies. Finding what works for you is important. Talking to family and friends helps many people. There is also help and support available from specialist nurses, counsellors and support groups.

You can get emotional and practical support through:

• your healthcare team at the hospital

• staff at your GP practice

• charities

• local support groups