A 32-year-old man presents with a 2-month history of a painless left testicular mass. AFP is 380 ng/mL, beta-hCG is normal, LDH is normal. CT shows retroperitoneal lymphadenopathy up to 2.8 cm. Post-orchidectomy histology shows pure yolk sac tumor (non-seminomatous GCT). How is this staged and what is the preferred treatment?
- A Stage IIC; BEP × 4 cycles
- B Stage IIB; BEP × 3 cycles or 4 cycles EP depending on S category ✓
- C Stage IS (rising AFP post-orchidectomy); BEP × 3 cycles
- D Stage IIA; surveillance alone is appropriate
Explanation
NSGCT with retroperitoneal nodes 2–5 cm is Stage IIB. AFP elevation plus retroperitoneal adenopathy confirms systemic disease. The international prognostic classification (IGCCCG) and EAU guidelines recommend BEP × 3 cycles for good-prognosis Stage IIB NSGCT, or 4 cycles of EP as equivalent for good-prognosis group. Stage IIC is nodes >5 cm. Stage IS (elevated markers after orchidectomy with no radiographic metastases) also mandates chemotherapy, not surveillance, because of high relapse risk. Stage IIA (nodes <2 cm) may be managed with primary RPLND or surveillance in selected patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.