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Testicular germ cell tumours
A testicular tumour in a young man is removed through the groin, the markers AFP, β-hCG and LDH guide stage and prognosis, and even metastatic disease is cured in most cases with cisplatin-based chemotherapy (BEP).
Why it matters in the exam
Testicular tumours appear in the exam almost every year. Questions cover the meaning of a raised AFP in seminoma, the treatment of seminoma with a single retroperitoneal metastasis, the international risk groups, and the treatment of a tumour refractory to BEP.
A particularly recurring topic is bleomycin: lung toxicity, its risk factors, the need for lung function tests, and caution with high-concentration oxygen during surgery. Another scenario is a young man with dyspnoea, confusion and a mediastinal mass or bleeding metastases — think of choriocarcinoma with a very high β-hCG.
Key points
- A testicular tumour is removed through the groin, and AFP, β-hCG and LDH are measured before and after orchiectomy.
- Stage I seminoma is usually managed by close surveillance alone, because most patients will not relapse; a raised AFP means the tumour has a nonseminomatous component.
- Metastatic disease is treated by the international risk group with BEP or EP, and even in the poor-risk group many young patients are cured.
- Bleomycin causes lung toxicity — check lung function including diffusion before each cycle, stop when it falls, and avoid high-concentration oxygen.
- Refractory to BEP there is still a chance of cure with TIP or high-dose chemotherapy and autologous transplant.
Summary table
| Situation | Treatment | Exam detail |
|---|---|---|
| Diagnosis | Testicular ultrasound, markers, and inguinal orchiectomy | Never a trans-scrotal biopsy; sperm banking before treatment |
| Seminoma stage I | Surveillance (preferred), or a single dose of carboplatin, or radiation | A raised AFP excludes pure seminoma — treat as nonseminoma |
| Seminoma stage IIA–IIB | Radiation to retroperitoneal and pelvic nodes, or chemotherapy | A single small metastasis — radiation of 30 Gy or BEP for 3 cycles |
| Nonseminoma stage I | Surveillance, or one cycle of BEP when there is vascular invasion | Retroperitoneal node dissection in selected cases |
| Metastatic disease | Good risk: BEP for 3 cycles or EP for 4; intermediate or poor: BEP for 4 cycles | Seminoma is never poor risk; a residual mass in nonseminoma — resect it (teratoma) |
| Refractory or relapsed disease | Salvage chemotherapy (TIP) or high-dose chemotherapy with autologous transplant | Still a chance of cure |
| Bleomycin toxicity | Pneumonitis and fibrosis | Risk: age above 40, renal failure, smoking, high cumulative dose, high-concentration oxygen |
In the full version for subscribers
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The full version is open to subscribers of: Oncology, Urology, Medical licensing exam (IMLE).
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Sources
- NCCN Clinical Practice Guidelines in Oncology: Testicular Cancer, 2026 — Seminoma and nonseminoma
- EAU Guidelines on Testicular Cancer, 2025 — Disease management
- DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 12th ed. (2023) — Cancer of the testis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.