Testicular germ cell tumors: biology and clinical update

To discuss several important developments in the diagnosis, management, and risk stratification of testicular germ cell tumors (TGCTs) in the past year.

Germ cell function and tumorigenesis may be influenced by exposure to a variety of agents, including metals and cannabinoids. Genome-wide association studies have identified variants in several genes that may produce susceptibility to the development of testicular malignancies, and expression of certain proteins predicts a poorer prognosis and may, thus, play a role in neoplastic progression. Retroperitoneal lymph node dissection continues to play a crucial role in definitive treatment of patients with nonseminoma germ cell tumor, whereas radiotherapy, as a standard treatment for early-stage seminoma, has been declining due both to the efficacy of platinum-based chemotherapy and to the increased risk of radiation-related secondary malignancies. Advanced and platinum-refractory disease states continue to be challenging entities in terms of optimizing therapy and outcome.

Preclinical and clinical studies continue to enhance our insights into the complex biology of TGCTs, and are helping to further refine risk stratification and optimize treatment of patients with TGCTs.