Management of adult testicular germ cell tumours: summary of updated SIGN guideline

Explanation of SIGN grades of recommendations Initial assessment and referral in primary care Presenting symptoms and history of patients with testicular cancer include 5 : -A painless, solid, unilateral mass in the scrotum (most cases) -Enlarged testicle -Scrotal pain (20% of cases) -Backache (11%) -Gynaecomastia (7%) -Dragging sensation in the scrotum -Incidental recent trauma (it is not thought that the trauma causes the cancer, but rather that it brings an existing tumour to the attention of the patient and physician). For patients with metastases in whom the diagnosis is not in doubt (when there are high levels of tumour markers and a testicular mass on physical examination or ultrasound scan), immediate chemotherapy may be indicated. About 5% of all men with testicular cancer have contralateral carcinoma in situ, 7 but the prevalence is much higher (34%) in those in this age group who have a small contralateral testis. 8 When possible, perform contralateral testicular biopsy after all sperm samples have been obtained for storage and before chemotherapy or any secondary treatment (GPP). Stage and definition of disease Seminoma and non-seminomatous germ cell tumours (NSGCT) Treatment options Stage I: defined as no known residual disease after orchidectomy, with no evidence of metastatic disease on clinical examination and with normal computed tomogram of chest, abdomen, and pelvis, and normal postoperative tumour markers* Seminoma Discuss with patients the advantages and disadvantages of options for treatment after orchidectomy, including surveillance, single dose adjuvant carboplatin, and adjuvant radiotherapy NSGCT or mixed tumour (seminoma plus NSGCT)...