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Testicular Cancer — SCE Medical Oncology MCQ

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HardUrological CancersTesticular CancerSCE Medical Oncology

After first-line BEP for metastatic non-seminomatous germ-cell tumour, markers have normalised. CT shows a 2.4 cm retroperitoneal mass and a resectable 1.6 cm pulmonary mass. FDG-PET is equivocal. What is the oncological principle governing further management?

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Correct answer: B — Expert-centre resection of all visible residual masses larger than 1 cm

After chemotherapy for NSGCT, no clinical model or FDG-PET can reliably distinguish necrosis, teratoma and viable cancer. EAU guidance therefore recommends resection of visible residual masses larger than 1 cm when markers are normal or normalising, with sequencing planned in an experienced multidisciplinary centre. Marker normalisation does not exclude teratoma; salvage chemotherapy is for marker-positive or otherwise progressive disease, and teratoma is not managed by radiotherapy.

Reference: EAU guideline on testicular cancer: disease management (2026 limited update): https://uroweb.org/guidelines/testicular-cancer/chapter/disease-management