Workup/Staging

Question 1

Per NCCN, what 3 blood tests should be performed in the workup of a suspicious testicular mass?

Answer 1

There are 3 blood tests that should be performed in a man with a suspicious testicular mass: AFP, a-HCG, and a chemistry panel including LDH.

Question 2

How should a pt with pure seminoma histology and an elevated AFP be classified?

Answer 2

A pt with pure seminoma histology and an elevated AFP should be considered and treated as an NSGCT pt. AFP is not considered to be elevated in seminomatous germ cell tumor (SGCT).

Question 3

Per NCCN, what imaging study should be performed in the workup of a suspicious testicular mass?

Answer 3

CXR and testicular US should be performed in the workup of a suspicious testicular mass.

Question 4

How is the AJCC 8th edition staging for NSGCTs different from staging for SGCTs?

Answer 4

The AJCC staging is the same for both NSGCTs and seminomas. See seminoma staging for details.

Question 5

How should an NSGCT be definitively diagnosed?

Answer 5

Definitive Dx of an NSGCT should be via a radical inguinal orchiectomy. Do not Bx a testicular mass (separate inguinal lymphatic drainage of scrotum).

Question 6

Per NCCN, what should be discussed preoperatively with a pt who has a testicular mass?

Answer 6

The pros and cons of sperm banking should be discussed prior to orchiectomy.

Question 7

Per NCCN, what imaging study should be ordered postoperatively after Dx of NSGCT?

Answer 7

CT abdomen/pelvis (CT A/P) ± chest imaging should be performed postoperatively after the Dx of NSGCTs.

Question 8

Per the International Germ Cell Cancer Collaborative Group, what 5 factors must be met to be classified as good-risk NSGCT?

Answer 8

Per the International Germ Cell Cancer Collaborative Group (JCO 1997), good-risk NSGCT must meet all of the following:

1. Testicular or retroperitoneal primary tumor
2. No nonpulmonary visceral mets
3. AFP <1,000 ng/mL
4. β-HCG <5,000 mIU/mL
5. LDH <1.5 times the upper limit of normal

Question 9

Per the International Germ Cell Cancer Collaborative Group, what 3 factors must be met to be classified as intermediate-risk NSGCT?

Answer 9

Per the International Germ Cell Cancer Collaborative Group (JCO 1997), intermediate-risk NSGCT must meet both of the following:

1. Testicular or retroperitoneal primary tumor
2. No nonpulmonary visceral mets and any of the following intermediate-risk factors:
   3a. AFP 1,000–10,000 ng/mL

3b. β-HCG 5,000–50,000 mIU/mL
3c. LDH 1.5–10 times the upper limit of normal

Question 10

Per the International Germ Cell Cancer Collaborative Group, the presence of any of which 5 factors leads to classification of poor-risk NSGCT?

Answer 10

Per the International Germ Cell Cancer Collaborative Group (JCO 1997), poor-risk NSGCT has any of the following:

1. Mediastinal primary tumor
2. Nonpulmonary visceral mets
3. AFP >10,000 ng/mL
4. β-HCG >50,000 mIU/mL
5. LDH >10 times the upper limit of normal