Management of stage II nonseminomatous germ cell tumors
- Timothy D Gilligan, MD
Timothy D Gilligan, MD
- Associate Professor of Medicine
- Cleveland Clinic Lerner College of Medicine
- Vice-Chair for Education
- Cleveland Clinic Taussig Cancer Institute
- Director of Coaching, Center for Excellence in Healthcare Communication
- Cleveland Clinic
- Philip W Kantoff, MD
Philip W Kantoff, MD
- Section Editor — Testicular Cancer
- Chairman of Medicine
- Memorial Sloan Kettering Cancer Center
Testicular cancers, 95 percent of which are germ cell tumors (GCTs), are one of the most curable solid tumors. Testicular GCTs are more sensitive to systemic chemotherapy than most adult solid tumors. Chemotherapy is routinely administered with curative intent for men with metastatic seminomas or nonseminomatous GCTs (NSGCTs; ie, stage III disease (table 1 and table 2)) and for those with persistently elevated serum tumor markers following orchiectomy (stage Is).
The management of stage II NSGCTs requires an understanding of the appropriate roles of chemotherapy and retroperitoneal lymph node dissection (RPLND). In addition to chemotherapy, a curative approach to testicular cancer often requires surgery, in part because primary and metastatic tumors may contain teratoma, which is less prone to dissemination but more resistant to chemotherapy than other GCT histologies. (See "Serum tumor markers in testicular germ cell tumors".)
The management of stage II NSGCTs following orchiectomy will be reviewed here. An overview of the management of testicular cancer and the management of other stages of testicular cancer are discussed separately. (See "Overview of the treatment of testicular germ cell tumors" and "Management of stage I nonseminomatous germ cell tumors" and "Initial risk-stratified treatment for advanced testicular germ cell tumors".)
Stage II disease refers to cancers that have spread to the regional (ie, retroperitoneal) lymph nodes (table 2). Stage II disease can be defined based on either imaging alone (clinical stage II) or on a histopathological analysis showing germ cell tumor (GCT) in lymph nodes resected during a retroperitoneal lymph node dissection (RPLND) (pathologic stage II).
The length of short axis in the transverse plane is used to determine whether or not a lymph node is enlarged on cross-sectional imaging. (The length of lymph nodes in the craniocaudal direction, as can be measured if coronal or sagittal plane images are constructed, is of no importance to staging; all measurement cutoffs in this section refer to measurements in the transverse plane).
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- CLINICAL STAGE II NSGCT
- Normal tumor markers
- - Clinical stage IIA
- - Clinical stage IIB to IIC
- Elevated tumor markers
- Treatment of residual masses
- PATHOLOGIC STAGE II NSGCT
- Pathologic stage IIA disease
- Pathologic stage IIB/C disease
- SPECIAL CONSIDERATIONS
- SUMMARY AND RECOMMENDATIONS