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Management of stage II nonseminomatous germ cell tumors

Authors
Timothy D Gilligan, MD
Philip W Kantoff, MD
Section Editor
William K Oh, MD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

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".)

CLASSIFICATION

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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Literature review current through: Nov 2016. | This topic last updated: Fri Jun 26 00:00:00 GMT 2015.
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