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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.
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.
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.
Germ cell tumours drain along the spermatic cord to the para-aortic nodes high in the abdomen, not to the groin, which is why staging scans look at the retroperitoneum.
Same organ: Retroperitoneal germ cell tumour, Leydig cell tumour of the testis, Sertoli cell tumour of the testis, Spermatocytic tumour of the testis, Germ cell neoplasia in situ (GCNIS), Embryonal carcinoma of the testis, Yolk sac tumour of the testis, postpubertal type, Choriocarcinoma of the testis, Testicular germ cell tumours, Seminoma, Germ cell tumours of childhood and adolescence (extracranial and CNS)
Orchidectomy then surveillance; one cycle of adjuvant BEP for men with lymphovascular invasion who choose it; nerve-sparing retroperitoneal dissection in selected cases.
Three cycles of BEP (or four of EP if bleomycin is contraindicated).
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.
Retroperitoneal lymph node dissection and resection of other residual masses when markers have normalised.
Conventional (TIP) or high-dose chemotherapy with stem cell support, as compared in the TIGER trial; late relapse treated surgically where possible.
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Treatment intensity decisions still rest on the three IGCCCG groups, and the online calculator from this work gives men a more accurate individual estimate of cure.
Early tumour marker decline should guide treatment intensification in poor-prognosis germ cell tumours, which is now standard in expert centres.
Three cycles of BEP for good risk and four for intermediate and poor risk follow directly from this classification, which was updated in 2021 with modern survival figures.
BEP has been the backbone of curative chemotherapy for testicular cancer for nearly forty years.
Query for this cancer: (TITLE:"Non-seminomatous germ cell tumour" OR ABSTRACT:"Non-seminomatous germ cell tumour" OR TITLE:"NSGCT" OR ABSTRACT:"NSGCT" OR TITLE:"Non-seminoma" OR ABSTRACT:"Non-seminoma" OR TITLE:"Embryonal carcinoma" OR ABSTRACT:"Embryonal carcinoma" OR TITLE:"Yolk sac tumour" OR ABSTRACT:"Yolk sac tumour" OR TITLE:"Choriocarcinoma" OR ABSTRACT:"Choriocarcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Non-seminomatous germ cell tumour, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
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.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Reduce to 75% for CrCl 15-50.
Interstitial lung disease (ILD) is lung inflammation, a serious side effect of some ADCs (especially Enhertu) and immunotherapy.
See all on the product pages:BleomycinCisplatinEtoposide·Printable cards in the navigator
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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.
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