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9 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
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%.
Orchiectomy 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.
| Setting | Approach | Guideline |
|---|---|---|
| Stage I seminoma | Orchiectomy then surveillance (preferred); adjuvant carboplatin AUC 7 ×1 or para-aortic radiotherapy for those declining surveillance. | NCCN Category 2A (surveillance preferred) |
| Stage I non-seminoma | Surveillance (relapse ~15-50% by LVI status, all salvageable); or BEP ×1 or nerve-sparing RPLND for high-risk. | NCCN Category 2A |
| Metastatic, IGCCCG good risk | BEP ×3 or EP ×4; post-chemotherapy RPLND for residual non-seminoma masses >1 cm. | NCCN Category 1 |
| Metastatic, intermediate/poor risk | BEP ×4 (or VIP if bleomycin contraindicated); early marker-decline assessment to intensify (GETUG-13); brain metastases treated multimodally. | NCCN Category 1 |
| Relapsed | 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. | NCCN Category 2A |