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Budesonide ICI Colitis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyBudesonide ICI ColitisSCE Medical Oncology

A 29-year-old with metastatic non-seminomatous germ-cell tumour has normalised AFP and hCG after BEP, but serial CT shows enlarging retroperitoneal masses. Resection biopsy contains mature teratoma without viable malignant germ-cell elements. What is the definitive management?

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Correct answer: E — Complete surgical resection of enlarging masses when technically feasible

Enlarging masses with normalised germ-cell markers and mature teratoma after chemotherapy define growing-teratoma syndrome, treated by complete surgical resection. Arrange second-line chemotherapy for enlarging masses with normalised markers: growing teratoma is resistant to chemotherapy. Arrange radiotherapy for enlarging masses with normalised markers: mature teratoma is not reliably radiosensitive. Arrange serial imaging until tumour markers rise or symptoms develop: continued enlargement can cause major local morbidity while markers remain normal. Arrange image-guided biopsy of each enlarging mass before further treatment: one representative pathology plus the classic syndrome supports definitive complete resection.

Reference: Diagnosis and management of growing teratoma syndrome: single-centre experience and review (Published December 2018): https://pubmed.ncbi.nlm.nih.gov/30446456/; EAU guideline on testicular cancer: disease management (2026 limited update): https://uroweb.org/guidelines/testicular-cancer/chapter/disease-management; NICE CSG2 urological cancer service guidance (Current NICE service guidance, accessed July 2026): https://www.nice.org.uk/guidance/csg2