How do you approach a patient with multiply relapsed germ cell tumor with rising tumor markers but no obvious site of disease?

From the description, it presumes that this is a patient who previously received BEP, high dose chemo with transplant, and "radiotherapy". Not sure whether that represents CNS mets that were radiated. The most important aspect is to be certain marker rise due to progressive cancer. hCG mildly elevated (<50) can be due to marijuana (or possibly CBD oil) recent mononucleosis as heterophile antibody can cause an elevation in hCG or cross-reactivity with LH. I presume there was no evidence for active disease on chest, abd., and pelvic CT scan, head MRI or a second primary in the remaining testis to account for rising hCG or AFP. AFP elevations can be seen with liver disease and would expect elevated liver enzymes in that setting. An elevated LD...