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Management of Testicular Germ Cell Tumors

  • Therapy in Practice
  • Published:
American Journal of Cancer

Abstract

Germ cell tumors of the testis are the most common malignancy in men aged 20–40 years and the incidence is increasing at a rate of 15–20% every 5 years but with a wide geographical and racial variation. The cause of this rising incidence is not known but environmental estrogen levels have been hypothesized. Risk factors for developing testicular germ cell tumors (TGCT) include family history, cryptorchidism, and other testicular abnormalities. For most patients, primary treatment is by inguinal orchidectomy, though patients with advanced disease should receive primary chemotherapy. In patients with no discernible disease, the major treatment decision lies between immediate adjuvant treatment with radiotherapy (seminoma) or chemotherapy/surgery (nonseminomatous germ cell tumor) and surveillance with treatment at relapse. Either strategy would be expected to cure 99% of patients. Definition of prognostic groups, growing concerns over long term toxicity and improved diagnostic imaging are increasingly leading to the adoption of surveillance strategies.

A number of randomized trials have defined that for patients with metastatic disease, treatment with bleomycin, etoposide, and cisplatin (BEP) remains standard with 3 cycles being recommended for patients with good prognosis and 4 cycles for immediate/poor prognosis strategies. Following chemotherapy, the surgical removal of residual masses remains an important part of management. This treatment can have significant short term and long term toxicities, thus current research is directed towards improving cure rates in poorer risk groups and patients receiving salvage therapy; reducing toxicity remains an aim in good prognosis groups. Obtaining the best balance between cure and toxicity is complex and a number of studies have shown that optimal results are obtained by treatment in specialized centers.

Considerable progress has been made in the management of TGCT in the last 30 years, the remaining challenge is to build on the successes to deliver optimal care to this group of patients.

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Acknowledgements

This work was undertaken in The Royal Marsden National Health Service (NHS) Trust who received a proportion of its funding from the NHS Executive; the views expressed in this publication are those of the authors and not necessarily those of the NHS Executive. This work was supported by the Institute of Cancer Research, the Bob Champion Cancer Trust and Cancer Research UK. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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  1. The Academic Unit of Radiotherapy & Oncology, The Royal Marsden NHS Trust & The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT, UK

    Robert A. Huddart, David P. Dearnaley & Alan Horwich

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  1. Robert A. Huddart
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Huddart, R.A., Dearnaley, D.P. & Horwich, A. Management of Testicular Germ Cell Tumors. Am J Cancer 2, 325–334 (2003). https://doi.org/10.2165/00024669-200302050-00003

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