Seminoma or Nonseminoma Is the First Major Branch Point
Almost all testicular cancers begin in germ cells. A pure seminoma is generally more sensitive to radiation and follows a different staging and treatment pathway than nonseminoma. Nonseminoma may contain embryonal carcinoma, yolk-sac tumor, choriocarcinoma, teratoma or a mixture of germ-cell types. A tumor containing both seminoma and nonseminoma is treated as nonseminoma.
Exact Cell Type
The orchiectomy report should describe tumor type, size, lymphovascular invasion, invasion into nearby structures and whether margins are involved.
AFP, Beta-hCG and LDH
Markers are measured before and after orchiectomy. Their pattern and rate of decline help establish stage, risk group and whether active disease may remain.
Where Disease Has Spread
CT imaging commonly evaluates retroperitoneal lymph nodes, lungs and other possible metastatic sites. Imaging is interpreted together with pathology and markers.
Good, Intermediate or Poor Risk
For metastatic germ-cell cancer, the primary site, sites of spread and tumor-marker levels guide the International Germ Cell Cancer Collaborative Group risk category.

