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Stage I NSGCT — SCE Medical Oncology MCQ

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ModerateUrological CancersStage I NSGCTSCE Medical Oncology

A 35-year-old man with stage I non-seminomatous germ cell tumour (pT2 — lymphovascular invasion present) undergoes orchidectomy. Post-operative markers normalise. CT staging is clear. According to risk-adapted management, what option should be discussed given the presence of LVI?

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Correct answer: A — Surveillance (preferred) OR 1 cycle of adjuvant BEP — LVI is the key risk factor for relapse in stage I NSGCT (~50% relapse rate with LVI vs ~15% without)

Lymphovascular invasion (LVI) is the most important risk factor for relapse in stage I NSGCT, increasing relapse risk from approximately 15% (no LVI) to approximately 50% (LVI present). Risk-adapted options include: (1) surveillance with early chemotherapy at relapse (preferred by many UK centres), or (2) 1 cycle of adjuvant BEP (reduces relapse to <3%). The SWENOTECA experience supports 1-cycle BEP for high-risk stage I NSGCT. The choice should be discussed with the patient.

Reference: ESMO 2024 Testicular Cancer Guidelines; SWENOTECA; NICE NG