Late relapse of testis cancer.

Most relapses of germ-cell tumors occur within 2 years of initial treatment. In 2% to 4% of patients, relapse may occur later. The retroperitoneum is the primary site of late relapse, and alpha-fetoprotein is the predominant marker. These tumors are highly resistant to chemotherapy. Surgical resection is the preferred treatment. If the recurrent disease is inoperable, chemotherapy may be instituted, followed by resection of residual masses. Patients successfully managed for testis cancer need lifelong surveillance.