Two Onc Docs Testicular Cancer 2025 UPDATE Part 2 (Non-Seminoma)
Apr 22, 2025
A deep dive into non-seminoma testicular cancer reveals vital tumor markers like AFP, LDH, and HCG essential for diagnosis. The management strategies for both early-stage and advanced disease are explored, emphasizing personalized treatment plans. Key discussions include the importance of monitoring long-term side effects and fertility issues. The surgical approach to managing residual disease is highlighted, along with upcoming trial results shedding light on chemotherapy options for relapsed cases. This enlightening conversation underscores advances in treatment and patient care.
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Use Post-Orchiectomy Markers
- Always measure AFP, LDH, and HCG tumor markers when testicular cancer is suspected.
- Use tumor markers after orchiectomy for prognosis, not before diagnosis.
Master Testicular Cancer Staging
- Know testicular cancer staging: Stage 1 (testis only), Stage 2 (retroperitoneal nodes, good risk markers), Stage 3 (other metastases or poor risk markers).
- Use specific AFP, HCG, and LDH cutoffs to categorize tumor marker risk and consider brain MRI for neurologic symptoms or very high HCG.
Non-Seminoma Treatment Paradigm
- For stage 1 and 2A non-seminoma with normal markers, prefer surveillance or consider one cycle of BEP if risk features exist.
- Use BEP x3 or EP x4 for good risk metastatic disease and escalate to BEP x4 or VIP x4 for intermediate or poor risk; consider RPLND for residual masses >1 cm.