A patient with a history of testicular germ cell tumor may experience a relapse many years later. Any patient with a malignant germ cell tumor needs to have lifelong follow-up for recurrence.
Risk factors for the patient:
(1) high initial tumor burden
(2) suboptimal management of the initial tumor based on current standards
(3) not being regularly monitored for recurrent tumor (with a delay in diagnosis)
(4) attempting to treat recurrent tumor with chemotherapy alone
(5) not being referred to a cancer center experienced with germ cell tumors
(6) not basing therapy on a representative biopsy of the recurrent tumor and a review of previous regimens
Management strategies:
(1) A localized tumor can be cured by surgery alone.
(2) A chemotherapy-naïve patient may benefit from cisplatin-based chemotherapy.
(3) One strategy for treatment of a large tumor is initial chemotherapy to shrink the tumor followed by surgery.
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