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Embryonal carcinoma is the most aggressive and most common building block of non-seminoma testicular cancer, made of primitive cells that resemble an early embryo and can turn into the other tumour types. On its own or as the main component it spreads early to lymph nodes and lungs, but it is highly sensitive to cisplatin chemotherapy and most men are cured.
Embryonal carcinoma is a germ cell tumour of totipotent cells growing in solid, papillary and glandular patterns with marked atypia, arising from germ cell neoplasia in situ and forming part of most mixed non-seminomatous tumours (Moch 2016). OCT4 (POU5F1), the pluripotency transcription factor, stains embryonal carcinoma and seminoma in every case among 91 testicular neoplasms tested and no other tumour type, and CD30 and SOX2 separate embryonal carcinoma from seminoma (Am J Surg Pathol 2004). Its share of a mixed tumour and the presence of lymphovascular invasion are the two histological risk factors used to decide adjuvant treatment of stage I non-seminoma.
How it differs from its parent: the non-seminoma page covers the group; embryonal carcinoma is its most proliferative component, does not raise alpha-fetoprotein on its own (a raised value implies yolk sac elements) and raises beta-hCG only modestly, and its predominance marks a higher relapse risk after orchidectomy.
How common: no separate incidence figure; it is present in most non-seminomas (Am J Surg Pathol 2004).
Treatment: as non-seminoma by stage and International Germ Cell Cancer Collaborative Group risk group: orchidectomy, then surveillance or one cycle of BEP for stage I depending on lymphovascular invasion and embryonal carcinoma predominance, and three or four cycles of BEP for metastatic disease with resection of residual masses (NCI PDQ testicular summary and the parent page).
The commonest component of non-seminomatous germ cell tumours: 54 of 64 mixed germ cell tumours in a marker study contained embryonal carcinoma, more than seminoma (51), yolk sac tumour (38) or teratoma (Am J Surg Pathol 2004). Pure embryonal carcinoma is a minority of testicular cancers; no registry figure was found in the sources read.
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), Yolk sac tumour of the testis, postpubertal type, Choriocarcinoma of the testis, Testicular germ cell tumours, Seminoma, Non-seminomatous germ cell tumour, Germ cell tumours of childhood and adolescence (extracranial and CNS)
Treated as non-seminoma by stage and risk group: orchidectomy, surveillance or one cycle of BEP for stage I by risk factors, three or four cycles of BEP for metastatic disease with resection of residual masses.
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Query for this cancer: (TITLE:"Embryonal carcinoma of the testis" OR ABSTRACT:"Embryonal carcinoma of the testis" OR TITLE:"Embryonal carcinoma" OR ABSTRACT:"Embryonal carcinoma" OR TITLE:"Testicular embryonal carcinoma" OR ABSTRACT:"Testicular embryonal carcinoma" OR TITLE:"Pure embryonal carcinoma" OR ABSTRACT:"Pure embryonal carcinoma" OR TITLE:"Embryonal carcinoma-predominant mixed germ cell tumour" OR ABSTRACT:"Embryonal carcinoma-predominant mixed germ cell tumour") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Embryonal carcinoma of the testis, not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
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.
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