# Non-seminomatous germ cell tumour

Source: https://onco.cc/cancers/non-seminoma/  
OnCo record `non-seminoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Non-seminoma is the faster-growing half of testicular cancer, marked by AFP and hCG in the blood. Surgery cures most early cases, cisplatin chemotherapy cures most of the rest, and surgeons remove what remains after chemotherapy because teratoma does not respond to drugs.

## Summary

Non-seminomatous germ cell tumours include embryonal carcinoma, yolk sac tumour, choriocarcinoma and teratoma, usually mixed. AFP, hCG and LDH set the IGCCCG risk group and track response. After orchidectomy, stage I disease is watched, with about 30 percent relapsing (more with lymphovascular invasion) and almost all cured on relapse; one cycle of adjuvant BEP is offered to higher-risk men who prefer it. Metastatic disease receives three cycles of BEP for good risk and four for intermediate and poor risk; residual masses after chemotherapy are resected by retroperitoneal lymph node dissection because a third contain teratoma and a tenth viable cancer. Relapse is treated with conventional or high-dose salvage chemotherapy, compared head to head in the TIGER trial. Fertility preservation and long-term follow-up are routine.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: NSGCT; Non-seminoma; Embryonal carcinoma; Yolk sac tumour; Choriocarcinoma; Teratoma; Mixed germ cell tumour
- Tags: subtype-page
- Group: genitourinary
- Burden: Just under half of testicular germ cell tumours, in men in their twenties and thirties; cure rates are above 95 percent for early disease and about half for the small poor-risk group, whose treatment is the hardest problem left in testicular cancer.
- Subtypes: Embryonal carcinoma; Yolk sac tumour; Choriocarcinoma (very high hCG, haemorrhagic metastases); Teratoma (chemoresistant; surgery); Mixed germ cell tumour; Growing teratoma syndrome
- Biomarkers: AFP, hCG and LDH (IGCCCG risk grouping); Lymphovascular invasion (stage I relapse risk); Marker decline during chemotherapy; Chromosome 12p gain (i12p) on pathology

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/non-seminoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/non-seminoma/#overview [3 subtypes, 3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/non-seminoma/#what-it-is [9 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/non-seminoma/#finding-it [4 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/non-seminoma/#treating-it [5 settings, 4 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/non-seminoma/#evidence [2 trials, 4 key papers, 4 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/non-seminoma/#science [1 target]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/non-seminoma/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/non-seminoma/#living-with-it [19 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/non-seminoma/coming/ [3 medicines, 2 medicines in the subtypes, 2 trials, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/non-seminoma/data/ [18 connected records]

## Standard of care

- Stage I: Orchidectomy then surveillance; one cycle of adjuvant BEP for men with lymphovascular invasion who choose it; nerve-sparing retroperitoneal dissection in selected cases. ([Bleomycin](https://onco.cc/drugs/bleomycin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Active surveillance](https://onco.cc/technologies/active-surveillance/))
- Metastatic, good risk: Three cycles of BEP (or four of EP if bleomycin is contraindicated). ([Bleomycin](https://onco.cc/drugs/bleomycin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Cisplatin](https://onco.cc/drugs/cisplatin/))
- Metastatic, intermediate and poor risk: Four cycles of BEP, or VIP; poor-risk patients with slow marker decline are switched to intensified therapy (GETUG 13); treatment in high-volume centres. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [Etoposide](https://onco.cc/drugs/etoposide/), [GETUG 13](https://onco.cc/trials/getug-13/))
- Residual masses after chemotherapy: Retroperitoneal lymph node dissection and resection of other residual masses when markers have normalised. ([Testicular germ cell tumours](https://onco.cc/cancers/testicular/))
- Relapse: Conventional (TIP) or high-dose chemotherapy with stem cell support, as compared in the TIGER trial; late relapse treated surgically where possible. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/))

## State of the art

- Testicular cancer was the first disseminated solid tumour to become curable with chemotherapy, and cure rates keep rising through risk adaptation.
- Post-chemotherapy surgery is a defining feature: teratoma and residual cancer are cut out rather than treated with more drugs.
- The remaining frontier is the poor-risk group and the balance between cure and late toxicity.

## Open problems

- Poor-risk disease still kills about half of those affected.
- Whether high-dose chemotherapy is better than conventional salvage (TIGER).
- Cardiovascular disease, hearing loss and neuropathy in long-term survivors.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Testicular_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Testicular_cancer

## Connected records

- cancers: [Choriocarcinoma of the testis](https://onco.cc/cancers/testicular-choriocarcinoma/), [Embryonal carcinoma of the testis](https://onco.cc/cancers/embryonal-carcinoma-testis/), [Germ cell neoplasia in situ (GCNIS)](https://onco.cc/cancers/germ-cell-neoplasia-in-situ/), [High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)](https://onco.cc/cancers/high-risk-gtn/), [Mediastinal germ cell tumour](https://onco.cc/cancers/mediastinal-germ-cell-tumour/), [Retroperitoneal germ cell tumour](https://onco.cc/cancers/retroperitoneal-germ-cell-tumour/), [Seminoma](https://onco.cc/cancers/seminoma/), [Testicular germ cell tumours](https://onco.cc/cancers/testicular/), [Yolk sac tumour of the testis, postpubertal type](https://onco.cc/cancers/yolk-sac-tumour-postpubertal/)
- key papers: [GETUG 13: personalised chemotherapy based on tumour marker decline in poor-prognosis germ cell tumours](https://onco.cc/key-papers/paper-getug-13-marker-guided-dose-dense-chemotherapy-fizazi-lancet-oncol-2014/), [IGCCCG Update Consortium: predicting outcomes in men with metastatic non-seminomatous germ cell tumours](https://onco.cc/key-papers/paper-igcccg-update-gillessen-jco-2021/), [International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers](https://onco.cc/key-papers/paper-igcccg-classification-jco-1997/), [Treatment of disseminated germ cell tumours with cisplatin, bleomycin and either vinblastine or etoposide](https://onco.cc/key-papers/paper-williams-bep-vs-pvb-nejm-1987/)
- drugs: [Bleomycin](https://onco.cc/drugs/bleomycin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Etoposide](https://onco.cc/drugs/etoposide/)
- trials: [GETUG 13](https://onco.cc/trials/getug-13/), [TIGER: standard-dose TIP versus high-dose TI-CE with stem cell transplant as first salvage for relapsed germ cell tumours](https://onco.cc/trials/tiger-trial/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [AFP, hCG and LDH in germ cell tumours (IGCCCG risk groups)](https://onco.cc/technologies/germ-cell-tumour-markers/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/)

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JSON: https://onco.cc/api/v1/entities/non-seminoma.json