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, it will most likely be within 2 years of finishing your treatment.
It is called a late relapse if your cancer comes back more than 2 years after treatment to cure you. This doesn't happen very often. Only around 2 or 3 out of 100 people with testicular cancer (around 2-3%) 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
- whereabouts 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 lot of treatment you have is called second line treatment.
Chemotherapy is a common second line treatment for recurrent testicular cancer. You might have surgery, 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)
- high dose chemotherapy
Doctors want to know whether high dose chemotherapy works better than standard dose chemotherapy, if your cancer comes back. There is a clinical trial comparing usual dose chemotherapy with high dose chemotherapy.
Surgery
You might have surgery to remove:
- lymph nodes in your tummy (retroperitoneal lymph node dissection)
- secondary cancer in your lungs
Timing of surgery
If you need to have surgery, you usually have the operation after chemotherapy. You usually need surgery if the cancer hasn't shrunk completely and doctors can still see it on the scan.
In some situations you might have an operation straight away when you relapse. This is more likely:
- if your doctors want to find out more about your type of cancer
- your non seminoma cancer has come back more than 2 years after treatment and the surgeon is able to remove it
If your seminoma cancer comes back more than 2 years after treatment, you usually have chemotherapy rather than surgery.
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 third line chemotherapy using the drugs gemcitabine and oxaliplatin.
Or you might have other drugs as part of a clinical trial.
Coping with relapse
It can be a big shock hearing that your cancer has come back. It can feel very difficult having to face treatment again. You may be coping with a range of feelings such as shock, frustration and fear.
You might need further tests to find out more about where the cancer is in your body. This will help your doctors decide what your treatment options are.
Your specialist doctor and 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 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.
