NSGCT

Non-seminomatous germ cell tumor (NSGCT) is a subset of testicular germ cell tumors defined by non-seminomatous histology. NSGCTs include embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed forms. They typically affect young men and often present as a painless testicular mass.

Unlike seminoma, NSGCTs frequently elevate serum tumor markers such as alpha-fetoprotein (AFP) and beta-hCG; teratoma usually lacks marker elevation. LDH may be raised but is non-specific. Diagnosis combines histopathology after inguinal orchiectomy with baseline marker assessment and imaging for staging.

Staging uses TNM and, for metastatic disease, the IGCCCG risk groups (good, intermediate, poor). Localized disease (Stage I) may be managed by surveillance or adjuvant therapy; retroperitoneal lymph node dissection (RPLND) is another option in select patients.

Advanced NSGCT or extensive retroperitoneal disease is treated with platinum-based chemotherapy, most commonly BEP (bleomycin, etoposide, cisplatin). If bleomycin is unsuitable, VIP (etoposide, ifosfamide, cisplatin) is used. Residual masses after chemotherapy may require surgical resection. Orchiectomy is the initial standard procedure.

Fertility considerations are important; many patients are young and may bank sperm before treatment. With current therapies, cure rates are high, especially for good- and intermediate-risk disease, though prognosis worsens for poor-risk metastatic NSGCT.