Seminoma
Seminoma is the slower, more radiosensitive half of testicular cancer. After removal of the testicle most men need no further treatment and are simply monitored; those who relapse or present with spread are cured with a short course of chemotherapy.
Overview
Seminoma arises from germ cell neoplasia in situ and presents as a painless testicular mass, with modest rises in hCG and LDH but never AFP, which would mark a non-seminomatous element. After radical inguinal orchidectomy, stage I disease is managed by surveillance in most men, since only about one in six relapse and all are salvageable; a single dose of carboplatin (MRC TE19) or, rarely now, para-aortic radiotherapy are alternatives. Stage II disease with small nodes is treated with radiotherapy or chemotherapy, and bulkier or metastatic disease with three cycles of BEP or four of EP, curing more than 90 percent; residual masses after chemotherapy are assessed with PET rather than removed. Long-term follow-up watches for second cancers and cardiovascular effects of treatment.
State of the art
- Surveillance has replaced adjuvant radiotherapy as the standard for stage I, sparing most men any treatment beyond surgery.
- Cure rates above 95 percent make late toxicity, second cancers and heart disease the main concern.
- De-escalation trials aim to cut chemotherapy and radiotherapy doses further in stage II.
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 epitheliumAdvanced seminoma (IGCCCG good or intermediate risk)
- Epididymis and cord
- para-aortic (retroperitoneal)
- left renal hilum (left testis)
- inguinal (only after scrotal surgery)
Same organ: Testicular germ cell tumours, Non-seminomatous germ cell tumour, Germ cell tumours of childhood and adolescence (extracranial and CNS)
Just over half of testicular germ cell tumours, peaking in men in their thirties; almost every patient is cured, and the effort now goes into giving the least treatment that keeps it that way.
- 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; single-dose carboplatin as an alternative; radiotherapy now rarely used because of second cancers.
Radiotherapy for small-volume nodes or chemotherapy (BEP or EP) for larger nodes; de-escalation trials of carboplatin with radiotherapy ongoing.
Three cycles of BEP or four of EP for good risk, four cycles of BEP for intermediate risk; PET-directed management of residual masses.
Subtypes & biomarkers
top- Stage I seminoma (surveillance)
- Stage II seminoma (nodal)
- Advanced seminoma (IGCCCG good or intermediate risk)
- Spermatocytic tumour (older men, almost never metastasises)
- hCG (mildly raised in a minority) and LDH
- AFP normal by definition
- Tumour size and rete testis invasion (relapse risk in stage I)
- PET after chemotherapy for residual masses over 3 cm
How often this target appears
- 1977Einhorn's cisplatin combination cures metastatic germ cell tumours
- 2005MRC TE19: single-dose carboplatin equals radiotherapy in stage I
- 2011Surveillance endorsed as the preferred stage I option in Europe
What is in development for Seminoma, 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
Predicting which stage I patients will relapse.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseAvailable now- Liquid biopsy (ctDNA)Standard of care
- MRD / molecular residual disease testingEstablished
- Multiparameter flow cytometry MRDStandard of care
- NGS-based MRD (clonoSEQ and molecular MRD)Standard of care
- SignateraEstablished
- Structured exercise programmes after curative treatmentEstablished
In trials- ADAURAPositive
- CAMBRIA-1 & CAMBRIA-2Active
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
- ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ)Emerging
- DYNAMICPositive
- IMvigor011Positive
Ideas and roadmaps- A blood test for the pre-metastatic niche
- A bone marrow niche on a chip to study human dormancy
- A dedicated clinic for people whose blood test says the cancer is back
- A drug screen that only rewards killing sleeping cancer cells
- A national platform trial that every ctDNA-positive patient can join
- A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled
Background: Circulating tumour DNA (ctDNA), Disseminated tumour cells (DTCs), Late recurrence, Minimal / molecular residual disease (MRD), MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶). Also on OnCo: Treatment journeys · Survivorship planner.
Late effects of platinum and radiotherapy decades on.
and how the field plans to fix it →What is being done about thisSide effects and quality of lifeAvailable now- IMRT / IGRT (modern external beam)Standard of care
- Cardio-oncologyEstablished
- Exercise & lifestyle oncologyEstablished
- Geriatric assessmentEstablished
- 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.
Rare relapses more than five years out.
and how the field plans to fix it →What is being done about thisRare cancers and small trialsAvailable now- AI trial matching & clinical decision supportEstablished
- Comprehensive genomic profilingStandard of care
- Dinutuximab (ch14.18) / dinutuximab betaApproved
- Eflornithine (DFMO)Approved
- LarotrectinibApproved
- Limb-salvage surgery and endoprosthetic reconstructionStandard of care
In trials- ACTIONRecruiting
- COG AALL1731Positive
- COG ANBL0032Positive
- DeFiPositive
- Euro Ewing 2012Positive
- Functional (ex vivo) drug testingEmerging
Ideas and roadmaps- A digital second-opinion network answering community oncologists within 72 hours
- A DRUP-style protocol for off-label generic targeted drugs in rare tumours
- A funded expert second opinion for every new high-stakes or rare cancer diagnosis
- A global first-in-human network for academic cancer trials with single ethics review
- A global open trials operating system any hospital can plug into
- A live 'seats available' feed for trial slots, like airline inventory
Background: Basket, umbrella, and platform trials, Centralisation and high-volume centres, FNCLCC grade (soft-tissue sarcoma), Histotype-tailored therapy, INRG staging and risk groups. Also on OnCo: Find a trial · Expert centres.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Expert centres
topExpert centres
- Institute of Oncology LjubljanaLjubljana, SIvia Carboplatin, IMRT / IGRT (modern external beam)
- Aarhus University HospitalAarhus, DKvia IMRT / IGRT (modern external beam)
- Alliance for Clinical Trials in OncologyChicago, IL, USvia Carboplatin
- American Society for Radiation OncologyArlington, VA, USvia IMRT / IGRT (modern external beam)
- Cancer Care Alberta (Alberta Health Services)Calgary, AB, CAvia PET (positron emission tomography)
- Centre Antoine LacassagneNice, FRvia IMRT / IGRT (modern external beam)
- Centre Oscar LambretLille, FRvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Comprehensive Cancer Center Freiburg (CCCF)Freiburg im Breisgau, DEvia IMRT / IGRT (modern external beam)
- European Society for Radiotherapy and OncologyBrussels, BEvia IMRT / IGRT (modern external beam)
- Geneva University Hospitals (HUG)Geneva, CHvia IMRT / IGRT (modern external beam)
- German Breast Group (GBG)Neu-Isenburg, DEvia Carboplatin
- Groote Schuur Hospital / University of Cape TownCape Town, ZAvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Hacettepe University Cancer InstituteAnkara, TRvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Ho Chi Minh City Oncology HospitalHo Chi Minh City, VNvia IMRT / IGRT (modern external beam)
- Hokkaido University HospitalSapporo, JPvia IMRT / IGRT (modern external beam)
- Hunan Cancer HospitalChangsha, CNvia IMRT / IGRT (modern external beam)
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolis, IN, USNCI comprehensivevia Cisplatin
- Institut BergoniéBordeaux, FRvia IMRT / IGRT (modern external beam)
- Institut National d'Oncologie, RabatRabat, MAvia IMRT / IGRT (modern external beam)
- Institut Salah AzaïezTunis, TNvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- International Extranodal Lymphoma Study GroupBellinzona, CHvia IMRT / IGRT (modern external beam)
- IRCCS Humanitas Research HospitalRozzano (Milan), ITvia IMRT / IGRT (modern external beam)
- Istanbul University Institute of OncologyIstanbul, TRvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Juravinski Cancer Centre / Escarpment Cancer Research InstituteHamilton, ON, CAvia IMRT / IGRT (modern external beam)
- Kenyatta National HospitalNairobi, KEvia IMRT / IGRT (modern external beam)
- Korle Bu Teaching HospitalAccra, GHvia IMRT / IGRT (modern external beam)
- Lagos University Teaching HospitalLagos, NGvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- National Institute of Oncology, HungaryBudapest, HUvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Ocean Road Cancer InstituteDar es Salaam, TZvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Rajiv Gandhi Cancer Institute and Research CentreNew Delhi, INvia IMRT / IGRT (modern external beam)
- Rambam Health Care CampusHaifa, ILvia IMRT / IGRT (modern external beam)
- Rigshospitalet, Copenhagen University HospitalCopenhagen, DKvia IMRT / IGRT (modern external beam)
- Royal Adelaide HospitalAdelaide, AUvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Siriraj Hospital, Mahidol UniversityBangkok, THvia IMRT / IGRT (modern external beam)
- Society of Nuclear Medicine and Molecular ImagingReston, VA, USvia PET (positron emission tomography)
- Tata Medical Center, KolkataKolkata, INvia IMRT / IGRT (modern external beam)
- Tawam HospitalAl Ain, AEvia IMRT / IGRT (modern external beam)
- Tel Aviv Sourasky Medical CenterTel Aviv, ILvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- TROG Cancer ResearchNewcastle, NSW, AUvia IMRT / IGRT (modern external beam)
- UMC Utrecht Cancer CenterUtrecht, NLvia IMRT / IGRT (modern external beam)
- University of Malaya Medical CentreKuala Lumpur, MYvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Velindre Cancer CentreCardiff, GBvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Zhejiang Cancer HospitalHangzhou, CNvia IMRT / IGRT (modern external beam)
Questions to ask
topQuestions to ask your oncologist about Seminoma
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 hCGand LDH, AFP normal by definition, Tumour size and rete testis invasion, PET after chemotherapy for residual masses over 3 cm), 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 Stage I seminoma, Stage II seminoma, Advanced seminoma.
- 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; single-dose carboplatin as an alternative; radiotherapy now rarely used because of second cancers.
- Am I a candidate for Carboplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Stage II
- For my situation (stage ii), which of the standard options do you recommend and why?Why: Guideline options include: Radiotherapy for small-volume nodes or chemotherapy (BEP or EP) for larger nodes; de-escalation trials of carboplatin with radiotherapy ongoing.
- Am I a candidate for Cisplatin, Etoposide, Bleomycin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Advanced
- For my situation (advanced), which of the standard options do you recommend and why?Why: Guideline options include: Three cycles of BEP or four of EP for good risk, four cycles of BEP for intermediate risk; PET-directed management of residual masses.
- 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.
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 “Predicting which stage I patients will relapse”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Late effects of platinum and radiotherapy decades on”. 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
8targets
1drugs
4Latest papers
topQuery for this cancer: (TITLE:"Seminoma" OR ABSTRACT:"Seminoma" OR TITLE:"Classic seminoma" OR ABSTRACT:"Classic seminoma" OR TITLE:"Pure seminoma" OR ABSTRACT:"Pure seminoma" OR TITLE:"Germinoma when in the brain" OR ABSTRACT:"Germinoma when in the brain") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Seminoma, not a curated reading list.
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