The first 60 days: Testicular germ cell tumours
Testicular germ cell tumours are the most curable adult solid cancer: cisplatin-based chemotherapy cures the large majority even when the disease has spread to distant sites. Today's research is about giving less treatment to the majority who are cured, rescuing the minority who relapse, and limiting lifelong survivorship harms. Below, week by week, is what OnCo's record of Testicular germ cell tumours 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 seminoma, Stage I non-seminoma.
- SurgeonNamed in the standard of care for: Stage I seminoma, Stage I non-seminoma, Metastatic, IGCCCG good risk, Metastatic, intermediate/poor risk and 1 more.
- Medical oncologistNamed in the standard of care for: Stage I seminoma, Stage I non-seminoma, Metastatic, IGCCCG good risk, Metastatic, intermediate/poor risk and 1 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Stage I seminoma.
- Transplant and cell therapy teamNamed in the standard of care for: Stage I non-seminoma, Metastatic, IGCCCG good risk, Metastatic, intermediate/poor risk, Relapsed.
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 seminomaNCCN category Category 2A (surveillance preferred), NCCN Guidelines: Testicular Cancer
Orchiectomy then surveillance (preferred); adjuvant carboplatin AUC 7 ×1 or para-aortic radiotherapy for those declining surveillance.
Surveillance (relapse ~15-50% by LVI status, all salvageable); or BEP ×1 or nerve-sparing RPLND for high-risk.
BEP ×3 or EP ×4; post-chemotherapy RPLND for residual non-seminoma masses >1 cm.
BEP ×4 (or VIP if bleomycin contraindicated); early marker-decline assessment to intensify (GETUG-13); brain metastases treated multimodally.
TIP or VeIP conventional-dose salvage, or high-dose carboplatin-etoposide with autologous stem-cell rescue (TI-CE); TIGER phase 3 compares the two; late relapse and teratoma need surgery.
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, LDH, miR-371a-3p, i/ 12p gain, Rete testis and lymphovascular invasion, Tumour size >4 cm), 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 Seminoma, Non-seminoma: embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed, Germ cell neoplasia in situ.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Stage I seminoma
- For my situation (stage i seminoma), which of the standard options do you recommend and why?Guideline options include: Orchiectomy then surveillance (preferred); adjuvant carboplatin AUC 7 ×1 or para-aortic radiotherapy for those declining surveillance.
- Am I a candidate for Carboplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Stage I non-seminoma
- For my situation (stage i non-seminoma), which of the standard options do you recommend and why?Guideline options include: Surveillance (relapse ~15-50% by LVI status, all salvageable); or BEP ×1 or nerve-sparing RPLND for high-risk.
- 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, IGCCCG good risk
- For my situation (metastatic, igcccg good risk), which of the standard options do you recommend and why?Guideline options include: BEP ×3 or EP ×4; post-chemotherapy RPLND for residual non-seminoma masses >1 cm.
- 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/poor risk
- For my situation (metastatic, intermediate/poor risk), which of the standard options do you recommend and why?Guideline options include: BEP ×4 (or VIP if bleomycin contraindicated); early marker-decline assessment to intensify (GETUG-13); brain metastases treated multimodally.
- Am I a candidate for Bleomycin, Etoposide, Cisplatin or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Relapsed
- For my situation (relapsed), which of the standard options do you recommend and why?Guideline options include: TIP or VeIP conventional-dose salvage, or high-dose carboplatin-etoposide with autologous stem-cell rescue (TI-CE); TIGER phase 3 compares the two; late relapse and teratoma need surgery.
- Am I a candidate for Paclitaxel / nab-paclitaxel, Ifosfamide, Cisplatin or related drugs, 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 Autologous stem cell transplant (high-dose therapy), Carboplatin?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 “Platinum-refractory disease has no effective therapy; checkpoint inhibitors were inactive”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Late effects of cisplatin (cardiovascular disease, second cancers, hearing loss) in men cured in their 20s”. 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.
- Testicular germ cell tumours: the full pageTesticular germ cell tumours are the most curable adult solid cancer: cisplatin-based chemotherapy cures the large majority even when the disease has spread to distant sites. Today's research is about giving less treatment to the majority who are cured, rescuing the minority who relapse, and limiting lifelong survivorship harms.
- 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.
- Late recurrence: Hormone-driven breast cancer can come back 10 or even 20 years after treatment, unlike most cancers, which is why hormone therapy lasts so long.
- Alpha-fetoprotein (AFP): Alpha-fetoprotein is a protein made by the fetal liver that a substantial share of hepatocellular carcinomas switch back on.
- Retroperitoneum: The space at the back of the abdomen, behind the gut's lining, holding the kidneys, adrenals, pancreas, aorta and the para-aortic lymph nodes.
- Adolescent and young adult (AYA) oncology: Cancer in people aged 15-39, about 90,000 US cases a year, with a distinct mix of cancers, slower survival improvement than children or older adults, and specific needs: fertility, education and work, psychosocial support and trial access.
Every term links to the glossary.