Non-seminomatous germ cell tumour
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.
Overview
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.
State of the art
- 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.
Anatomy and lymph node drainage
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.
- Germinal epitheliumEmbryonal carcinoma · Yolk sac tumour · Choriocarcinoma (very high hCG, haemorrhagic metastases) · Teratoma (chemoresistant; surgery) · Mixed germ cell tumour · Growing teratoma syndrome
- Epididymis and cord
- para-aortic (retroperitoneal)
- left renal hilum (left testis)
- inguinal (only after scrotal surgery)
Same organ: Testicular germ cell tumours, Seminoma, Germ cell tumours of childhood and adolescence (extracranial and CNS)
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.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
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.
Subtypes & biomarkers
top- Embryonal carcinoma
- Yolk sac tumour
- Choriocarcinoma (very high hCG, haemorrhagic metastases)
- Teratoma (chemoresistant; surgery)
- Mixed germ cell tumour
- Growing teratoma syndrome
- AFP, hCG and LDH (IGCCCG risk grouping)
- Lymphovascular invasion (stage I relapse risk)
- Marker decline during chemotherapy
- Chromosome 12p gain (i12p) on pathology
How often this target appears
- 1977Cisplatin combination chemotherapy cures metastatic disease (Einhorn)
- 1987BEP becomes the standard (etoposide replaces vinblastine)
- 1997IGCCCG risk classification published
- 2014GETUG 13: marker-guided intensification in poor-risk disease
What is in development for Non-seminomatous germ cell tumour, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
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.
and how the field plans to fix it →What is being done about thisSide effects and quality of lifeAvailable now- Cardio-oncologyEstablished
- Exercise & lifestyle oncologyEstablished
- Geriatric assessmentEstablished
- IMRT / IGRT (modern external beam)Standard of care
- Oncology nutrition assessment and medical nutrition therapyEstablished
- Proton therapyEstablished
In trialsIdeas and roadmaps- A cheap old tablet to restore appetite
- A coordinated FLASH radiotherapy evidence programme with shared dose-rate standards
- A dedicated programme for cachexia and treatment toxicity research
- A dietitian in every gastrointestinal and head and neck tumour board
- A funded programme of organ-preservation trials to avoid radical surgery
- A lifelong late-effects registry linked to every treatment for adult survivors
Background: CTCAE toxicity grading (grade 3-4 adverse events), De-escalation, escalation and response-adapted therapy, Immune-related adverse events (irAEs), Quality of life, Toxicity grade. Also on OnCo: Side effects by symptom · Immune-related side effects · Toxicity compare · Survivorship planner.
Trials
topTrials recruiting now
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Expert centres
topExpert centres
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolis, IN, USNCI comprehensivevia Cisplatin, Testicular germ cell tumours
Questions to ask
topQuestions to ask your oncologist about Non-seminomatous germ cell tumour
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example AFP, hCG and LDH, Lymphovascular invasion, Marker decline during chemotherapy, Chromosome 12p gainon pathology), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Embryonal carcinoma, Yolk sac tumour, Choriocarcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Stage I
- For my situation (stage i), which of the standard options do you recommend and why?Why: Guideline options include: Orchidectomy then surveillance; one cycle of adjuvant BEP for men with lymphovascular invasion who choose it; nerve-sparing retroperitoneal dissection in selected cases.
- Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Metastatic, good risk
- For my situation (metastatic, good risk), which of the standard options do you recommend and why?Why: Guideline options include: Three cycles of BEP (or four of EP if bleomycin is contraindicated).
- Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Metastatic, intermediate and poor risk
- For my situation (metastatic, intermediate and poor risk), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Cisplatin, Etoposide, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Residual masses after chemotherapy
- For my situation (residual masses after chemotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Retroperitoneal lymph node dissection and resection of other residual masses when markers have normalised.
Relapse
- For my situation (relapse), which of the standard options do you recommend and why?Why: Guideline options include: Conventional (TIP) or high-dose chemotherapy with stem cell support, as compared in the TIGER trial; late relapse treated surgically where possible.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Poor-risk disease still kills about half of those affected”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Whether high-dose chemotherapy is better than conventional salvage (TIGER)”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
6targets
1drugs
3Latest papers
topQuery 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.
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