The first 60 days: 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. Below, week by week, is what OnCo's record of Non-seminomatous germ cell tumour says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Stage I.
- SurgeonNamed in the standard of care for: Stage I, Metastatic, good risk, Residual masses after chemotherapy, Relapse.
- Medical oncologistNamed in the standard of care for: Stage I, Metastatic, good risk, Metastatic, intermediate and poor risk, Relapse.
- Transplant and cell therapy teamNamed in the standard of care for: Stage I, Metastatic, good risk, Metastatic, intermediate and poor risk, Relapse.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.Stage I
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.
- 5.Relapse
Conventional (TIP) or high-dose chemotherapy with stem cell support, as compared in the TIGER trial; late relapse treated surgically where possible.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Embryonal carcinoma, Yolk sac tumour, Choriocarcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?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?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?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?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?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?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?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?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?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?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of TIGER: standard-dose TIP versus high-dose TI-CE with stem cell transplant as first salvage for relapsed germ cell tumours, Autologous stem cell transplant (high-dose therapy)?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?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?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?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?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Non-seminomatous germ cell tumour: the full pageNon-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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.