Skip to content
My WebMD Sign In, Sign Up

Cancer Health Center

Font Size

Testicular Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview

Testicular cancer is broadly divided into seminoma and nonseminoma for treatment planning because seminomatous types of testicular cancer are more sensitive to radiation therapy and chemotherapy and are less prone to distant metastases. Moreover, nonseminomas may include teratomatous elements, which tend to be resistant to chemotherapy and often require surgery for cure. By definition, pure seminomas do not contain elements of teratoma. Therefore, surgery plays a larger role in the management of nonseminomas than in the management of seminomas. Nonseminomatous testicular tumors include:

  • Embryonal carcinomas.
  • Yolk sac tumors.
  • Choriocarcinomas.
  • Teratomas.
  • Mixed germ cell tumors.

An international germ cell tumor prognostic classification has been developed based on a retrospective analysis of 5,202 patients with metastatic nonseminomatous and 660 patients with metastatic seminomatous germ cell tumors.[1] All patients received treatment with cisplatin- or carboplatin-containing therapy as their first chemotherapy course. The prognostic classification, shown below, was agreed on in 1997 by all major clinical trial groups worldwide. It should be used for reporting clinical trial results of patients with germ cell tumors.

Recommended Related to Cancer

Syndromes Associated with Osteosarcoma

Rothmund-Thomson Syndrome (RTS) Patients with RTS have an increased risk of developing osteosarcoma compared with the general population. They also tend to develop osteosarcoma at a younger age.[1] RTS, also called poikiloderma congenitale, is a rare autosomal recessive condition attributed to mutations of the RECQL4 helicase gene on 8q24. It is characterized by distinctive skin findings (atrophy, telangiectasias, pigmentation), sparse hair, cataracts, small stature, skeletal anomalies,...

Read the Syndromes Associated with Osteosarcoma article > >

A meta-analysis of treatment outcomes for patients with advanced nonseminoma suggested that 5-year survival rates have improved for those patients with a poor prognosis during the period of 1989 to 2004.[2] In addition to improved therapy, the improvement seen in these survival rates could be the result of publication bias, changes in patient selection in reported clinical trials, or more sensitive staging methods that could migrate less-advanced stages to more-advanced stage categories (i.e., stage migration).

Good Prognosis

Nonseminoma:

  • Testis/retroperitoneal primary, and
  • No nonpulmonary visceral metastases, and
  • Good markers–all of:
    • Alpha-fetoprotein (AFP) less than 1,000 ng/mL, and
    • Human chorionic gonadotropin (hCG) less than 5,000 IU/mL (1,000 ng/mL), and
    • Lactate dehydrogenase (LDH) less than 1.5 × the upper limit of normal

    56%–61% of nonseminomas

    5-year progression-free survival (PFS) is 89%; 5-year survival is 92%–94%

Seminoma:

  • Any primary site, and
  • No nonpulmonary visceral metastases, and
  • Normal AFP, any hCG, any LDH

    90% of seminomas

    5-year PFS is 82%; 5-year survival is 86%

Intermediate Prognosis

Nonseminoma:

  • Testis/retroperitoneal primary, and
  • No nonpulmonary visceral metastases, and
  • Intermediate markers–any of:
    • AFP 1,000 ng/mL or more and 10,000 ng/mL or less, or
    • hCG 5,000 IU/L or more and 50,000 IU/L or less, or
    • LDH 1.5 or more × N* and less than 10 × N*

    13%–28% of nonseminomas

    5-year PFS is 75%; 5-year survival is 80%–83%

    *N indicates the upper limit of normal for the LDH assay.

Seminoma:

  • Any primary site, and
  • Nonpulmonary visceral metastases, and
  • Normal AFP, any hCG, any LDH

    10% of seminomas

    5-year PFS is 67%; 5-year survival is 72%

Poor Prognosis

Nonseminoma:

  • Mediastinal primary, or
  • Nonpulmonary visceral metastases, or
  • For markers–any of:
    • AFP more than 10,000 ng/mL, or
    • hCG more than 50,000 IU/mL (10,000 ng/mL), or
    • LDH more than 10 × the upper limit of normal

    16%–26% of nonseminomas

    5-year PFS is 41%; 5-year survival is 71%

Seminoma:

  • No patients are classified as poor prognosis.

References:

  1. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 15 (2): 594-603, 1997.
  2. van Dijk MR, Steyerberg EW, Habbema JD: Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: An update based on meta-analysis. Eur J Cancer 42 (7): 820-6, 2006.
1

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Next Article:

Today on WebMD

Building a Support System
Blog
cancer fighting foods
SLIDESHOW
 
precancerous lesions slideshow
SLIDESHOW
quit smoking tips
SLIDESHOW
 
Jennifer Goodman Linn self-portrait
Blog
what is your cancer risk
HEALTH CHECK
 
colorectal cancer treatment advances
Video
breast cancer overview slideshow
SLIDESHOW
 
prostate cancer overview
SLIDESHOW
lung cancer overview slideshow
SLIDESHOW
 
ovarian cancer overview slideshow
SLIDESHOW
Actor Michael Douglas
Article