A 25-year-old male presents with acute onset painless left testicular swelling over 4 weeks. Serum AFP is 420 ng/mL (elevated), beta-hCG is 2 IU/L (normal), and LDH is normal. CT chest/abdomen/pelvis shows no metastasis. Orchidectomy specimen shows a pure yolk sac tumour. What stage and risk classification determines the next step in management?
- A Stage IA (pT1N0M0 S0), good prognosis IGCCCG — active surveillance recommended
- B Stage IS (pT1N0M0 S1 due to elevated AFP post-orchidectomy), IGCCCG good prognosis — surveillance vs BEP x2 ✓
- C Stage IIA (pT1N1M0 S1), intermediate prognosis — BEP chemotherapy x3 cycles
- D Stage IA (pT1N0M0 S1), intermediate prognosis — adjuvant BEP chemotherapy x2 cycles
Explanation
In testicular germ cell tumours, serum tumour markers (AFP, beta-hCG, LDH) must be reassessed post-orchidectomy. If AFP remains elevated after orchidectomy with no radiological evidence of metastasis, this is classified as Stage IS (elevated markers after orchidectomy with negative imaging) — indicating subclinical metastatic disease. IGCCCG classifies pure yolk sac tumour with AFP elevation and no non-pulmonary visceral metastasis as good prognosis. EAU guidelines recommend 2 cycles of BEP (bleomycin, etoposide, cisplatin) or surveillance in Stage IS good prognosis NSGCTs, as opposed to 3-4 cycles in advanced disease. Stage IA would require post-orchidectomy normal markers.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.