Version July 2025
AFP: alpha-fetoprotein; BEP: bleomycin, etoposide, and cisplatin; beta-hCG: beta human chorionic gonadotropin; CT: computed tomography; EP: etoposide and cisplatin; LDH: lactate dehydrogenase; LVI: lymphovascular invasion; NSGCT: nonseminomatous germ cell tumor; RPLND: retroperitoneal lymph node dissection; ULN: upper limit of normal; VIP: etoposide, ifosfamide, and cisplatin.
* Patients with pure seminoma on pathology but with an elevated AFP >30 ng/mL are classified as having NSGCT.
¶ Inguinal or pelvic lymph nodes are classified as distant metastases and constitute stage III disease.
Δ Refer to UpToDate content on management of advanced and metastatic testicular germ cell tumors.
◊ Involved lymph nodes are those with a short axis ≥10 mm.
§ All options are associated with a very high probability of cure. Choice is based upon a consideration of patient preference and available expertise.
¥ If RPLND is negative for disease or reveals only teratoma, we offer surveillance. If RPLND is positive for germ cell tumor elements other than teratoma (eg, embryonal carcinoma, seminoma, yolk sac tumor, and/or choriocarcinoma), options include either surveillance or adjuvant chemotherapy. For further details, refer to UpToDate content on treatment of stage II NSGCT.
‡ RPLND should be limited to centers with adequate surgical expertise.
† For select patients with non-bulky Stage IIB(S0) disease (retroperitoneal lymph nodes >2 and ≤3 cm), primary RPLND§ is an alternative option for those who wish to avoid the potential toxicities of chemotherapy and are willing to accept a potentially higher risk of recurrence.
