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ESMO E-Learning: Rational Treatment Delivery in Clinical Stage I and II Testicular Germ Cell Tumours (Including Long-Term Toxicities)


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Learning objectives

  1. To provide an update on treatment and follow-up in clinical stages I and II of testicular cancer
  2. To provide an update on risk factors for relapse in clinical stages I and II testicular cancer
  3. To provide an update on long term toxicities from treatments for clinical stages I and II testicular cancer
  4. To summarise current clinical dilemmas in the treatment of clinical stages I and II testicular cancer 


Testicular germ cell tumours represent a rare malignancy affecting mostly young males aged between 15 and 40 years. Approximately 50% of the testicular germ cell tumours are seminomas and 50% are non-seminomas. In men, the vast majority of germ cell tumours arise in the testicles with approximately 5% occurring outside the gonads.

Roughly 75% of all testicular germ cell tumours - 80% of seminomas and 60% of non-seminomas - are detected in clinical stage I. Orchiectomy alone cures 80% of seminomas and 70% of non-seminomas, and standard care has increasingly shifted to active surveillance. Patients with clinical stage I seminomas have a 13–19% rate of relapse. Patients with clinical stage I non-seminomas have a 30% risk of relapse, which may necessitate treatment.

In this E-Learning module the author provides an update on risk factors and presents dilemmas in identifying the risk factors in clinical stage I testicular cancer. Besides risk factors for relapse, in the first part of the presentation, the author elaborates treatment strategies for clinical stage I testicular cancer, follow-up and late side effects. He emphasizes that treatment options for clinical stage I testicular germ cell tumours are patient-driven. He underlines that the treatment options, whether they are risk-adapted or not, are equal for clinicians, however, not for patients. Patients with clinical stage I testicular cancer have a high probability to be cured, therefore the author digs into problems which are important in the survivorship setting.

In the second part of the presentation, the author focuses on dilemmas in clinical stage II testicular germ cell tumours. Both chemotherapy and radiotherapy provide excellent results in stage II disease and sustained efficacy at long term. However, the author reminds that in testicular cancer details of pros and cons for each therapeutic option matter. In overall, these patients have a good prognosis, and attempts to mitigate the long-term side effects of treatment are warranted. In that regard, the author gives details on rational treatment delivery.  

Declaration of interest

Andrea Necchi has reported:
Advisory board work for Roche, MSD, Astra Zeneca, Bayer and Janssen.
Research funding (Institution) from Millennium, Amgen, Astra Zeneca, MSD and Novartis.

Last update: 24 Mar 2017

This E-Learning module was published in 2017. The CME test expired in 2019.

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