Testicular Cancer

Questions discussed in this category

How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?

Would you biopsy lymph node to confirm recurrence/histology? If confirmed, how do you decide between RT vs chemotherapy? If chemo - BEP x3 vs E...

5 Answers available

In a patient with stage 1 mixed germ cell tumor who cleared tumor markers post-orchiectomy but with subsequent rise to borderline abnormal within 6 weeks, would you treat with 3 cycles BEP as for S1 disease?

If serum markers were normal, how strongly do you consider 1 cycle of BEP for embryonal predominant pathology?

1 Answer available

For a young male with Stage III intermediate risk NSGCT with active 1 ppd smoking history but normal PFTs and DLCO results, would you still consider use of BEP x 4?

VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked.

2 Answers available

Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?

1 Answer available

Do you routinely check Pulmonary function testing prior to each cycle of BEP for young patients with testicular cancer with no pulmonary risk factors?

NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP? What ...

2 Answers available

How would you approach therapy for a patient with non-seminomatous germ cell tumor, cT3N3Mx and symptomatic lower extremity thrombus extending to the IVC when it is unclear if bland or tumor thrombus?

HCG 850, AFP normal, LDH ~500 pre-orchiectomy. If tumor thrombus, would you favor 4c of BEP? Would you try biopsy it? How common is IVC thrombu...

1 Answer available

How do you approach therapy for a patient with stage IIIA NSGCT who received 4 cycles of EP followed by RPLND which revealed residual mixed teratoma and embryonal carcinoma?

Given persistent embryonal histology on RPLND, do you favor observation or TIP/VIP? What do you use to guide your decision?

1 Answer available

Would you change chemotherapy to VIP in a young patient with stage IIIB intermediate risk non-seminomatous germ cell tumor with borderline DLCO after one cycle of BEP?

2 Answers available

Would you give EP to a patient with Stage I testicular nonseminoma with risk factors (LVI and 90% embryonal), who is not a candidate for bleomycin?

If yes, how many cycles?

1 Answer available

Do you give adjuvant chemotherapy to a patient with a completely resected mediastinal pure seminoma?

What is your approach to a patient who underwent surgery for what was thought to be a thymoma, but ended up being a pure seminoma? No disease elsewher...

1 Answer available

How would you treat a patient with new isolated enlarged lymph node <6 months after RPLND with prior pT2NX non-seminoma treated with orchiectomy then RPLND within 1 year due to nodal metastases?

1 Answer available

Would you give EP chemotherapy to a patient with Stage IIA nonseminoma with negative markers who underwent RPLND and had pN2 disease with predominant teratoma?

Would you think differently about chemotherapy based on %teratoma or size of lymph nodes vs number of lymph nodes (eg. multiple small LN vs single 2-5...

1 Answer available

What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?

Does patient age effect your approach? Would you consider RPLND for any patients in light of the phase II SEMS trial presented at the 2021 ASCO GU Ca...

3 Answers available

How would you manage asymptomatic brain metastases from testicular non-seminomatous germ cell tumor with a choriocarcinomatous component?

2 Answers available

How would you treat an older patient with stage IIC nonseminoma who is unfit for platinum chemotherapy due to comorbidities?

Are there any chemotherapy regimens that can be used in elderly patients with poor PS who are not candidate for BEP?

2 Answers available

How would you treat a patient with late relapsed metastatic seminoma with only large (>10cm) pulmonary metastases and LDH nine times the upper limit of normal?

In reviewing the data, LDH does not upstage to intermediate risk but those patients tend to do worse. Would one treat this patient as intermediate ri...

2 Answers available

Will you offer adjuvant BEP after orchiectomy to a patient with embryonal carcinoma, solely based on the size at presentation, such as a 6 cm testicular mass?

Negative surgical margin, normal post-orchiectomy markers and no lymph node and distant metastasis

1 Answer available

How would you approach a pT2 nonseminomatous testicular cancer, embryonal caricnoma with +LVI with persistent b-hcg < 20 post-operatively?

2 Answers available

How would you treat a recurrent seminoma after 1st line BEP, now growing during salvage TIP despite initial response?

2 Answers available

How would you manage a patient with stage 1 seminoma on surveillance without prior radiation or chemotherapy who develops para-aortic lymphadenopathy without increase in tumor markers?

Would you radiate? Surgery? Chemo? Follow with short interval scans? How would size of adenopathy (e.g. <2cm vs larger) and time of recurrence (wi...

1 Answer available

How would you treat a patient with metastatic Leydig cell tumor of the testes with extensive lung and abdominal metastases (peritoneum, retroperitoneal LN and soft tissue) following orchiectomy and maximal surgical resection of abdominal disease?

2 Answers available

How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?

1 Answer available

How do you treat primary retroperitoneal choriocarcinoma with liver and lung metastases and markedly elevated B-HCG?

If no testicular mass on exam or ultrasound - is there a role for orchiectomy? What chemotherapy regimen would you use and how many cycles?

3 Answers available

What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?

How does your approach differ for patients with stage IIA versus IIB disease? Age?

3 Answers available

How do you stage patients with testicular cancer who may have CSIS disease?

An ASCO 2020 poster from the German Testicular Cancer Study Group found that 37% of CSIS seminoma and nonseminoma were miscatagorized resulting in ina...

1 Answer available

What is your approach to unresectable metastatic rhabdomyosarcoma transformed from an embryonal cell germ cell tumor?

Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?

1 Answer available

How do you treat a patient with a history of clinical stage IIb cN2, mixed germ cell embryonal carcinoma treated with BEP and RPLND five years ago, who now has signet ring cell adenocarcinoma with abdominal carcinomatosis with an unknown primary?

GI work up negative. NGS cancer type and isochromosome 12p ordered and pending. Pathology at RPLND was negative for cancer.

3 Answers available

In what situations do you utilize G-CSF in germ cell tumors or Hodgkin lymphoma patients receiving bleomycin?

There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.

2 Answers available

Is there a role for high-dose chemotherapy in a patient with metastatic choriocarcinoma with brain-only recurrence within two years of diagnosis after prior treatment with first and second line chemotherapy (BEP x4 and VIP x3)?

Brain metastases have undergone resection, SBRT and WBRT

1 Answer available

What is the longest acceptable interval between radical orchiectomy and adjuvant BEP for Stage IIB/III pure seminoma in the age of COVID-19?

2 Answers available

Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?

1 Answer available

Would you offer salvage chemotherapy to a patient with stage IIIC poor risk NSGCT in whom AFP fail to normalize even after 2 months of completion of 4 cycles BEP?

Residual disease with bulky retroperitoneal masses also present on scans

1 Answer available

Is orchiectomy necessary for a patient with primary retroperitoneal seminoma and calcifications seen on testicular ultrasound (but no primary testicular mass)?

2 Answers available

Would you treat a patient with testicular cancer stage I, pure seminoma on orchiectomy, but with high bHCG (in 1000s) as seminoma or as non-seminoma?

1 Answer available

How do you treat metastatic testicular cancer with the primary orchiectomy pathology showing non-seminoma with components of teratoma and primitive neuroectodermal tumor?

Are there any special considerations with the PNET?

1 Answer available

Is it reasonable to offer 3-days BEP regimen to a patient with high risk mixed germ cell tumor due to compliance issues?

3 Answers available

In a patient with primary mediastinal seminoma with normalization of biomarkers s/p EPx4 and residual non-FDG avid mass, would you consider resection of residual tumor vs surveillance?

2 Answers available

What type of surveillance plan should one use to follow a young person after orchiectomy for a >3cm pure mature teratoma of the testicle?

1 Answer available

Would you continue bleomycin in a patient with intermediate risk stage 3B nonseminona who had a pulmonary embolism?

2 Answers available

How would you treat a residual mediastinal mass in patients with a mediastinal germ cell tumor with an incomplete response to primary chemotherapy with BEPx4?

i.e. gross disease on scans that is too diffuse to be removed completely and/or decreasing but not normal markers Do you pursue close surveillance, s...

1 Answer available

Do you routinely use tumor lysis prophylaxis when starting chemotherapy for germ cell tumors?

How do you assess risk of tumor lysis syndrome, and is hydration sufficient or should hypouricemic agents be used as well?

2 Answers available

What chemotherapy regimen would you give for metastatic adenocarcinoma that arose from teratoma/germ cell tumor?

Late relapse, previously treated with BEP 30 years ago.

1 Answer available

Is it unusual to have isolated LDH elevation and normal HCG and AFP in non-seminomatous germ cell tumor (embryonal carcinoma)?

In a patient s/p orchiectomy and with pelvic lymphadenopathy, would you consider lymph node biopsy to confirm involvement by non-seminomatous germ cel...

2 Answers available

How would you approach risk-stratification/staging of a extra-gonadal germ cell tumor with both mediastinal and retroperitoneal lymphadenopathy?

Is there any role for orchiectomy in this setting?

1 Answer available

For patients with seminoma testicular cancer who are Stage II (positive retroperitoneal lymph nodes), what factors do you consider when choosing between radiation versus chemotherapy?

1 Answer available

In a patient with a history of treated stage II seminoma with rising bHCG while on surveillance, do you routinely recheck the bHCG with a different assay?

When are you concerned for a false positive? FDA guidelines include a suggestion to try another assay in case heterophile antibodies are causing a fal...

1 Answer available

For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?

Is any amount of teratoma or PNET an indication for surgery?

1 Answer available

Are there ever indications to include the inguinal nodes in the RT treatment field in a testicular seminoma?

Would a history of prior vasectomy in a stage IIA seminoma be an indication to include the inguinal nodes in the RT treatment field?

1 Answer available

What is the appropriate management of Stage 0 (testicular intratubular neoplasia) of the testicle?

Is there any advantage to primary RT as opposed to just orchiectomy? Additionally, in order to confirm Tis, a biopsy is required, which is typica...

1 Answer available

What factors would lead you to consider RT for men with Stage I seminoma?

The Chung validation study did not find that size > 4cm or rete testis invasion are risk factors for relapse and the current NCCN guideline discour...

2 Answers available