{"entity":{"id":"non-seminoma","kind":"cancer","name":"Non-seminomatous germ cell tumour","aka":["NSGCT","Non-seminoma","Embryonal carcinoma","Yolk sac tumour","Choriocarcinoma","Teratoma","Mixed germ cell tumour"],"tldr":"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.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Testicular_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Testicular_cancer"}],"tags":["subtype-page"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"notes":[],"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"],"standardOfCare":[{"setting":"Stage I","approach":"Orchidectomy then surveillance; one cycle of adjuvant BEP for men with lymphovascular invasion who choose it; nerve-sparing retroperitoneal dissection in selected cases.","refs":["bleomycin","etoposide","cisplatin","active-surveillance"]},{"setting":"Metastatic, good risk","approach":"Three cycles of BEP (or four of EP if bleomycin is contraindicated).","refs":["bleomycin","etoposide","cisplatin"]},{"setting":"Metastatic, intermediate and poor risk","approach":"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.","refs":["cisplatin","etoposide"]},{"setting":"Residual masses after chemotherapy","approach":"Retroperitoneal lymph node dissection and resection of other residual masses when markers have normalised.","refs":["testicular"]},{"setting":"Relapse","approach":"Conventional (TIP) or high-dose chemotherapy with stem cell support, as compared in the TIGER trial; late relapse treated surgically where possible.","refs":["cisplatin","autologous-stem-cell-transplant"]}],"stateOfArt":["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."],"history":[{"year":1977,"title":"Cisplatin combination chemotherapy cures metastatic disease (Einhorn)","refs":["cisplatin"]},{"year":1987,"title":"BEP becomes the standard (etoposide replaces vinblastine)","refs":["etoposide","bleomycin"]},{"year":1997,"title":"IGCCCG risk classification published","refs":[]},{"year":2014,"title":"GETUG 13: marker-guided intensification in poor-risk disease","refs":[]}],"pipeline":["tiger-trial","autologous-stem-cell-transplant"],"openProblems":["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."],"parent":"testicular"},"route":"/cancers/non-seminoma/","neighbours":{"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"}],"trial":[{"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/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"},{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"}],"cancer":[{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"}]}}