Testicular germ cell tumors: diagnosis, management, and the potential for cure

Even in advanced stages, testicular germ cell tumors are now curable. Pathologic classification proposed by W.H.O. affords more precise histologic definition; nevertheless, an improved staging classification more relevant to combination chemotherapy is required. Diagnostic evaluation should include the newer serum protein markers, lymphangiography as well as ultrasound and/or computerized axial tomography when clinically indicated. Combination chemotherapy drug regimens have made a major impact on survival of patients with testicular germ cell tumors because they can induce a high percentage of durable complete remissions. Only prospective trials can define the optimum number of drugs needed and the length of time of treatment to obtain cure. The role of combined modality therapy (radiation, reductive surgery, chemotherapy) needs to be further defined. It is hoped that ongoing clinical trials will answer many of these important questions.