{"entity":{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","aka":["Seminoma","Non-seminomatous germ cell tumour","NSGCT"],"tldr":"Testicular germ cell tumours are the most curable adult solid cancer: cisplatin-based chemotherapy cures the large majority even when the disease has spread to distant sites. Today's research is about giving less treatment to the majority who are cured, rescuing the minority who relapse, and limiting lifelong survivorship harms.","summary":"Testicular germ cell tumours (GCTs) are seminomas or non-seminomas (embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma, mixed), arising from germ cell neoplasia in situ, almost universally carrying 12p gain (i(12p)). Serum tumour markers (AFP, hCG, LDH) stage and monitor the disease; miR-371a-3p is a more sensitive marker entering practice. The IGCCCG classification (1997, updated 2021) divides metastatic disease into good, intermediate and poor prognosis with 5-year survival of ~95%, ~90% and ~65-70%.\n\nOrchiectomy is followed by surveillance for most stage I disease; adjuvant carboplatin (seminoma) or one cycle of BEP (non-seminoma) are options for high-risk stage I. Metastatic disease receives BEP ×3 (good risk) or ×4 (intermediate/poor), or EP ×4 when bleomycin is contraindicated; residual masses after chemotherapy in non-seminoma are resected (retroperitoneal lymph node dissection). Relapse is treated with conventional-dose salvage (TIP, VeIP) or high-dose chemotherapy with autologous stem-cell rescue (TI-CE); the TIGER trial directly compares these. Survivorship (cardiovascular risk, second cancers, hypogonadism, infertility, ototoxicity, neuropathy) is a central concern because patients live 50+ years after cure.","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Testicular_cancer","links":[{"label":"NCCN Guidelines: Testicular Cancer","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1468"},{"label":"IGCCCG Update (JCO 2021)","url":"https://doi.org/10.1200/JCO.20.03296"},{"label":"NCI PDQ: testicular cancer","url":"https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq"}],"tags":["gap-fill","genitourinary","aya"],"related":["paediatric-germ-cell-tumours"],"cancers":[],"sections":[],"technologies":["platinum","cytotoxic-chemotherapy","autologous-stem-cell-transplant","active-surveillance","fertility-preservation","survivorship-care-plan"],"targets":["tp53"],"drugs":["cisplatin","carboplatin","etoposide","bleomycin","ifosfamide","paclitaxel","vinblastine"],"companies":[],"institutions":[],"pathways":[],"terms":["afp","late-recurrence","retroperitoneum"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["journal-of-adolescent-and-young-adult-oncology"],"dependsOn":[],"notes":[],"group":"genitourinary","burden":"The most common cancer in men aged 15-40; about 75,000 cases per year worldwide (GLOBOCAN) with cure rates above 95% overall and ~80% even in metastatic disease.","subtypes":["Seminoma","Non-seminoma: embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed","Germ cell neoplasia in situ (precursor)","Extragonadal (mediastinal, retroperitoneal) GCT","Spermatocytic tumour (older men, indolent)"],"biomarkers":["AFP, hCG, LDH (S stage; IGCCCG risk)","miR-371a-3p (emerging, high sensitivity for viable GCT)","i(12p) / 12p gain","Rete testis and lymphovascular invasion (stage I risk)","Tumour size >4 cm (seminoma stage I risk)"],"standardOfCare":[{"setting":"Stage I seminoma","approach":"Orchiectomy then surveillance (preferred); adjuvant carboplatin AUC 7 ×1 or para-aortic radiotherapy for those declining surveillance.","refs":["carboplatin","active-surveillance"],"guideline":{"nccn":"Category 2A (surveillance preferred)","version":"NCCN Guidelines: Testicular Cancer","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1468"}},{"setting":"Stage I non-seminoma","approach":"Surveillance (relapse ~15-50% by LVI status, all salvageable); or BEP ×1 or nerve-sparing RPLND for high-risk.","refs":["bleomycin","etoposide","cisplatin","active-surveillance"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Testicular Cancer"}},{"setting":"Metastatic, IGCCCG good risk","approach":"BEP ×3 or EP ×4; post-chemotherapy RPLND for residual non-seminoma masses >1 cm.","refs":["bleomycin","etoposide","cisplatin"],"guideline":{"nccn":"Category 1","version":"NCCN Guidelines: Testicular Cancer"}},{"setting":"Metastatic, intermediate/poor risk","approach":"BEP ×4 (or VIP if bleomycin contraindicated); early marker-decline assessment to intensify (GETUG-13); brain metastases treated multimodally.","refs":["bleomycin","etoposide","cisplatin","ifosfamide","getug-13"],"guideline":{"nccn":"Category 1","version":"NCCN Guidelines: Testicular Cancer"}},{"setting":"Relapsed","approach":"TIP or VeIP conventional-dose salvage, or high-dose carboplatin-etoposide with autologous stem-cell rescue (TI-CE); TIGER phase 3 compares the two; late relapse and teratoma need surgery.","refs":["paclitaxel","ifosfamide","cisplatin","carboplatin","etoposide","autologous-stem-cell-transplant"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Testicular Cancer"}}],"stateOfArt":["Cure rates above 95% are the benchmark for what chemotherapy can do; the field now works on de-escalation (surveillance for stage I, single-cycle adjuvant therapy) and survivorship.","miR-371a-3p promises to replace marker-negative uncertainty with a sensitive blood test for viable disease.","High-dose chemotherapy cures a substantial fraction of relapsed patients; TIGER will define its place.","Poor-risk disease and platinum-refractory GCT remain the unsolved minority; immunotherapy failed here."],"history":[{"year":1960,"title":"Li and colleagues: actinomycin D, methotrexate and chlorambucil active in GCT","refs":["methotrexate","dactinomycin"]},{"year":1974,"title":"Einhorn introduces cisplatin (PVB)","note":"Cure rates in metastatic disease jump from ~10% to ~60-70%.","refs":["cisplatin"]},{"year":1987,"title":"BEP replaces PVB (Williams, NEJM)","note":"Etoposide substitutes vinblastine with better efficacy and less neurotoxicity.","refs":["etoposide","bleomycin"]},{"year":1989,"title":"BEP ×3 sufficient for good-risk disease (Einhorn)","refs":[]},{"year":1997,"title":"IGCCCG prognostic classification","note":"Updated in 2021 with LDH and age refinements.","refs":[]},{"year":2005,"title":"Carboplatin ×1 equals radiotherapy for stage I seminoma (MRC TE19)","refs":["carboplatin"]},{"year":2014,"title":"Surveillance becomes standard for stage I","refs":[]},{"year":2019,"title":"miR-371a-3p validated as a serum marker (Dieckmann, JCO)","refs":[]}],"pipeline":["autologous-stem-cell-transplant","carboplatin"],"openProblems":["Platinum-refractory disease has no effective therapy; checkpoint inhibitors were inactive.","Late effects of cisplatin (cardiovascular disease, second cancers, hearing loss) in men cured in their 20s.","Over-treatment of stage I disease without reliable predictors.","Access to high-dose chemotherapy and expert RPLND outside specialist centres."]},"route":"/cancers/testicular/","neighbours":{"cancer":[{"id":"aya-cancers","kind":"cancer","name":"Adolescent and young adult cancers (ages 15 to 39)","route":"/cancers/aya-cancers/"},{"id":"cns-germ-cell-tumours","kind":"cancer","name":"Central nervous system germ cell tumours (germinoma and non-germinomatous)","route":"/cancers/cns-germ-cell-tumours/"},{"id":"testicular-choriocarcinoma","kind":"cancer","name":"Choriocarcinoma of the testis","route":"/cancers/testicular-choriocarcinoma/"},{"id":"embryonal-carcinoma-testis","kind":"cancer","name":"Embryonal carcinoma of the testis","route":"/cancers/embryonal-carcinoma-testis/"},{"id":"extragonadal-germ-cell-tumour","kind":"cancer","name":"Extragonadal germ cell tumour","route":"/cancers/extragonadal-germ-cell-tumour/"},{"id":"germ-cell-neoplasia-in-situ","kind":"cancer","name":"Germ cell neoplasia in situ (GCNIS)","route":"/cancers/germ-cell-neoplasia-in-situ/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"leydig-cell-tumour","kind":"cancer","name":"Leydig cell tumour of the testis","route":"/cancers/leydig-cell-tumour/"},{"id":"non-seminoma","kind":"cancer","name":"Non-seminomatous germ cell tumour","route":"/cancers/non-seminoma/"},{"id":"primary-testicular-lymphoma","kind":"cancer","name":"Primary large B-cell lymphoma of the testis","route":"/cancers/primary-testicular-lymphoma/"},{"id":"retroperitoneal-germ-cell-tumour","kind":"cancer","name":"Retroperitoneal germ cell tumour","route":"/cancers/retroperitoneal-germ-cell-tumour/"},{"id":"seminoma","kind":"cancer","name":"Seminoma","route":"/cancers/seminoma/"},{"id":"sertoli-cell-tumour","kind":"cancer","name":"Sertoli cell tumour of the testis","route":"/cancers/sertoli-cell-tumour/"},{"id":"spermatocytic-tumour","kind":"cancer","name":"Spermatocytic tumour of the testis","route":"/cancers/spermatocytic-tumour/"},{"id":"yolk-sac-tumour-postpubertal","kind":"cancer","name":"Yolk sac tumour of the testis, postpubertal type","route":"/cancers/yolk-sac-tumour-postpubertal/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"},{"id":"rejuv-ayac-distinct-group","kind":"technology","name":"Adolescents and young adults: a group with its own cancers, its own gap and its own needs","route":"/technologies/rejuv-ayac-distinct-group/"},{"id":"germ-cell-tumour-markers","kind":"technology","name":"AFP, hCG and LDH in germ cell tumours (IGCCCG risk groups)","route":"/technologies/germ-cell-tumour-markers/"},{"id":"rejuv-mind-anxiety-after-cancer","kind":"technology","name":"Anxiety after cancer, in survivors and in their partners","route":"/technologies/rejuv-mind-anxiety-after-cancer/"},{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"rejuv-mind-fear-of-recurrence","kind":"technology","name":"Fear that the cancer will come back: how common it is, and when it stops being ordinary worry","route":"/technologies/rejuv-mind-fear-of-recurrence/"},{"id":"rejuv-paed-fertility-male","kind":"technology","name":"Fertility in boys and young men treated for cancer, including testicular tissue banking","route":"/technologies/rejuv-paed-fertility-male/"},{"id":"sterile-injectable-generics-manufacturing","kind":"technology","name":"Generic sterile injectables (the 2023 platinum shortage)","route":"/technologies/sterile-injectable-generics-manufacturing/"},{"id":"rejuv-life-return-to-work","kind":"technology","name":"Going back to work after cancer: the rates, and the programmes that change them","route":"/technologies/rejuv-life-return-to-work/"},{"id":"hearing-after-platinum-chemotherapy","kind":"technology","name":"Hearing and tinnitus after platinum chemotherapy","route":"/technologies/hearing-after-platinum-chemotherapy/"},{"id":"rejuv-ayac-diagnostic-delay","kind":"technology","name":"How long it takes to diagnose cancer in a young person, and what the evidence actually says","route":"/technologies/rejuv-ayac-diagnostic-delay/"},{"id":"rejuv-life-insurance-loans-and-the-right-to-be-forgotten","kind":"technology","name":"Insurance, mortgages and the right to be forgotten","route":"/technologies/rejuv-life-insurance-loans-and-the-right-to-be-forgotten/"},{"id":"cipn-recovery-and-treatment","kind":"technology","name":"Nerve damage from chemotherapy: what recovers, and what helps","route":"/technologies/cipn-recovery-and-treatment/"},{"id":"fertility-preservation","kind":"technology","name":"Oncofertility and fertility preservation","route":"/technologies/fertility-preservation/"},{"id":"platinum","kind":"technology","name":"Platinum agents","route":"/technologies/platinum/"},{"id":"rejuv-mind-post-traumatic-growth","kind":"technology","name":"Post-traumatic growth: what people report, and what the measurement actually captures","route":"/technologies/rejuv-mind-post-traumatic-growth/"},{"id":"serum-tumour-markers","kind":"technology","name":"Serum tumour markers: proper use and misuse","route":"/technologies/serum-tumour-markers/"},{"id":"rejuv-ayac-services","kind":"technology","name":"Services built for teenagers and young adults, and what the national evaluation found","route":"/technologies/rejuv-ayac-services/"},{"id":"sexual-function-after-cancer","kind":"technology","name":"Sexual function and intimacy after cancer, for both sexes","route":"/technologies/sexual-function-after-cancer/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"testosterone-after-cancer-treatment","kind":"technology","name":"Testosterone after cancer treatment in men","route":"/technologies/testosterone-after-cancer-treatment/"},{"id":"rejuv-recovery-cumulative-dose","kind":"technology","name":"The cumulative dose that decides whether it comes back","route":"/technologies/rejuv-recovery-cumulative-dose/"},{"id":"cognitive-impairment-after-cancer-treatment","kind":"technology","name":"Thinking and memory after cancer treatment: what is measurable, and what helps","route":"/technologies/cognitive-impairment-after-cancer-treatment/"},{"id":"rejuv-recovery-matrix","kind":"technology","name":"What comes back after treatment, treatment by treatment","route":"/technologies/rejuv-recovery-matrix/"},{"id":"rejuv-access-fertility-preservation","kind":"technology","name":"Who gets told about fertility before treatment, and who does not","route":"/technologies/rejuv-access-fertility-preservation/"}],"target":[{"id":"cldn6","kind":"target","name":"Claudin 6","route":"/targets/cldn6/"},{"id":"kitlg","kind":"target","name":"KITLG","route":"/targets/kitlg/"},{"id":"ptma","kind":"target","name":"PTMA","route":"/targets/ptma/"},{"id":"tet1","kind":"target","name":"TET1","route":"/targets/tet1/"},{"id":"top2a","kind":"target","name":"Topoisomerase II alpha (TOP2A)","route":"/targets/top2a/"},{"id":"tp53","kind":"target","name":"TP53","route":"/targets/tp53/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"dactinomycin","kind":"drug","name":"Dactinomycin (actinomycin D)","route":"/drugs/dactinomycin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"ifosfamide","kind":"drug","name":"Ifosfamide","route":"/drugs/ifosfamide/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"paclitaxel","kind":"drug","name":"Paclitaxel / nab-paclitaxel","route":"/drugs/paclitaxel/"},{"id":"plicamycin","kind":"drug","name":"Plicamycin","route":"/drugs/plicamycin/"},{"id":"vinblastine","kind":"drug","name":"Vinblastine","route":"/drugs/vinblastine/"}],"term":[{"id":"aya-oncology","kind":"term","name":"Adolescent and young adult (AYA) oncology","route":"/terms/aya-oncology/"},{"id":"afp","kind":"term","name":"Alpha-fetoprotein (AFP)","route":"/terms/afp/"},{"id":"second-primary-bowel-after-abdominal-radiotherapy","kind":"term","name":"Bowel cancer after abdominal and pelvic radiotherapy","route":"/terms/second-primary-bowel-after-abdominal-radiotherapy/"},{"id":"rejuv-second-choices-made-at-treatment","kind":"term","name":"Choices made at the time of treatment that change the second cancer risk","route":"/terms/rejuv-second-choices-made-at-treatment/"},{"id":"late-recurrence","kind":"term","name":"Late recurrence","route":"/terms/late-recurrence/"},{"id":"retroperitoneum","kind":"term","name":"Retroperitoneum","route":"/terms/retroperitoneum/"},{"id":"rejuv-second-topoisomerase-inhibitors-short-latency","kind":"term","name":"Topoisomerase II inhibitors and the shorter latency","route":"/terms/rejuv-second-topoisomerase-inhibitors-short-latency/"},{"id":"rejuv-second-what-is-not-a-second-cancer","kind":"term","name":"What is not a second cancer: recurrence, metastasis and field cancerisation","route":"/terms/rejuv-second-what-is-not-a-second-cancer/"}],"journal":[{"id":"clinical-genitourinary-cancer","kind":"journal","name":"Clinical genitourinary cancer","route":"/journals/clinical-genitourinary-cancer/"},{"id":"european-urology-oncology","kind":"journal","name":"European Urology Oncology","route":"/journals/european-urology-oncology/"},{"id":"journal-of-adolescent-and-young-adult-oncology","kind":"journal","name":"Journal of adolescent and young adult oncology","route":"/journals/journal-of-adolescent-and-young-adult-oncology/"},{"id":"urologic-oncology","kind":"journal","name":"Urologic oncology","route":"/journals/urologic-oncology/"}],"trial":[{"id":"agct1531","kind":"trial","name":"AGCT1531","route":"/trials/agct1531/"},{"id":"getug-13","kind":"trial","name":"GETUG 13","route":"/trials/getug-13/"},{"id":"tiger-trial","kind":"trial","name":"TIGER: standard-dose TIP versus high-dose TI-CE with stem cell transplant as first salvage for relapsed germ cell tumours","route":"/trials/tiger-trial/"}],"person":[{"id":"lance-armstrong","kind":"person","name":"Lance Armstrong","route":"/people/lance-armstrong/"}],"institution":[{"id":"iu-simon","kind":"institution","name":"Indiana University Melvin and Bren Simon Comprehensive Cancer Center","route":"/institutions/iu-simon/"}],"paper":[{"id":"paper-getug-13-marker-guided-dose-dense-chemotherapy-fizazi-lancet-oncol-2014","kind":"paper","name":"GETUG 13: personalised chemotherapy based on tumour marker decline in poor-prognosis germ cell tumours","route":"/key-papers/paper-getug-13-marker-guided-dose-dense-chemotherapy-fizazi-lancet-oncol-2014/"}]}}