A 25-year-old man presents with a painless scrotal swelling. Ultrasound shows a 3 cm heterogeneous intratesticular mass. Tumour markers: AFP 1200 IU/mL, beta-hCG 350 IU/mL, LDH 2× ULN. After radical orchidectomy, histology confirms mixed non-seminomatous germ cell tumour (NSGCT). CT staging shows retroperitoneal lymph nodes 2.5 cm, no distant metastases. Stage IIA, IGCCCG good risk. The standard treatment is:

• A 4 cycles of EP (etoposide and cisplatin) without bleomycin
• B 3 cycles of BEP (bleomycin, etoposide, cisplatin) ✓
• C Retroperitoneal lymph node dissection (RPLND) alone without chemotherapy
• D Surveillance only after orchidectomy

Explanation

IGCCCG good-risk Stage II NSGCT is treated with 3 cycles of BEP (bleomycin + etoposide + cisplatin) as the standard of care, achieving cure rates >90%. The BEP regimen is preferred over 4 cycles EP because bleomycin adds meaningful benefit in germ cell tumours at this stage. RPLND alone is an option for clinical Stage I NSGCT or as salvage for residual mass post-chemotherapy (for teratoma). Surveillance is appropriate for Stage I low-risk NSGCT only. 4-cycle EP is used in poor-risk or bleomycin-contraindicated 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.