Understanding Nonseminomatous Germ Cell Tumors

A NSGCT is a type of testicular cancer that develops in cells that make sperm. Over 90% of testicular cancers are germ cell tumors.

Roughly half of germ cell tumors are seminomas, while the other half are nonseminomatous. There are several different types of NSGCT.

The symptoms of NSGCTs are similar to those of other types of testicular cancer and may include:

• a lump in your testicle that you can feel
• swelling in one testicle that causes it to become larger
• a feeling of heaviness in your scrotum
• pain or discomfort in your testicles or scrotum

It’s also possible for NSGCTs to be associated with infertility. This can be due to:

• low sperm counts
• poor sperm motility
• abnormally shaped sperm

There are four types of NSGCTs. Generally, each type of NSGCT is more common in mixed tumors. Pure tumors of each type are rarer.

Embryonal carcinoma

Embryonal carcinoma cells look like tissues found in early stage embryos when viewed under a microscope. They’re found in about 40% of testicular tumors.

Embryonal carcinomas are aggressive cancers. This means they have the potential to grow and spread rapidly.

Yolk sac carcinoma

Yolk sac carcinomas are named because they look like the yolk sac cells in an early embryo. They’re more common in children than in adults. They make up about 30% of testicular cancers in children ages 3 and younger.

Choriocarcinoma

Choriocarcinomas are made from cells that resemble components of the placenta. They’re aggressive, growing and spreading quickly.

Choriocarcinomas are rare and develop in adults. While pure choriocarcinomas are very rare, choriocarcinoma cells can be present in up to 15% of mixed germ cell tumors.

Teratoma

Teratomas are tumors that look like each of the layers of a developing embryo under a microscope. They can be either mature or immature.

Mature teratomas can contain different types of adult tissue, such as hair, bone, and cartilage. Immature teratomas are less well-developed and look like tissue from an early embryo.

Doctors and researchers don’t know what exactly causes NSGCTs. In general, cancer happens due to changes in the DNA of cells that cause them to grow uncontrollably.

But some things are known to increase a person’s risk of testicular cancer. These include having:

• a personal or family history of testicular cancer
• an undescended testicle or testicles, called cryptorchidism
• germ neoplasia in situ, a type of precancer in the testicles
• HIV

In the United States, the risk of testicular cancer is also four to five times higher in white people than in Black or Asian people. People living in the United States and Europe are also at a higher risk. The reasons for these differences aren’t known.

To make a diagnosis of NSGCT, your doctor will first take your medical history and do a physical exam. They will also feel your testicles for signs of any lumps, pain, or swelling.

Your doctor may order an ultrasound to help see whether a suspicious area is from a noncancerous health condition or from cancer.

Other imaging tests your doctor may order for NSGCT include:

• CT scan
• MRI scan
• PET scan
• chest X-ray
• bone scan

Checking for tumor markers

Because NSGCTs can make high levels of proteins called tumor markers, blood tests for these markers can help your doctor diagnose NSGCT.

Tumor markers used for NSGCT include:

• alpha-fetoprotein (AFP), which is often elevated in embryonal carcinoma and yolk sac carcinoma
• human chorionic gonadotropin (hCG), which is often high in embryonal carcinoma and choriocarcinoma
• lactate dehydrogenase (LDH), which can be raised in testicular cancer, particularly if cancer is widespread

Biopsies vs. surgeries

Biopsies aren’t taken to diagnose testicular cancer. This is because taking a biopsy can help the cancer cells spread.

If your doctor is highly suspicious that you have testicular cancer, they may recommend removing the affected testicle in a procedure called a radical orchiectomy.

A lab can then analyze the removed testicle for the presence of cancer. If cancer is present, the cancer can be characterized further.

The recommended treatment for NSGCT depends on several factors, such as the type of NSGCT you have, the stage of your NSGCT, and your age and overall health.

Treatment options for NSGCT may include one or a combination of the following:

• surgery to remove the affected testicle
• surgery to remove lymph nodes at the back of your abdomen
• chemotherapy, which typically includes one of the following regimens:
  • bleomycin, etoposide, and cisplatin (BEP)
  • etoposide and cisplatin (EP)
  • etoposide, ifosfamide, and cisplatin (VIP)

After your treatment, your doctor will monitor you in case the cancer comes back. You’ll visit your doctor regularly for check-ins, some of which will involve imaging.

As time passes without a relapse, the period between doctors’ visits will become longer.

Your outlook with NSGCT can depend on several factors, such as:

• the type of NSGCT you have
• the stage of your NSGCT
• how aggressive your NSGCT is
• the type of treatment used and how the cancer responds to it
• the levels of tumor markers in your blood after treatment
• your age and overall health

NSGCTs can be divided into three outlook categories based on several factors. These outlook categories are good, intermediate, and poor.

According to the National Cancer Institute, up to 61% of NSGCTs are in the good outlook category. The 5-year survival rates for each category are:

• Good: 92% to 94%
• Intermediate: 80% to 83%
• Poor: 71%

The table below shows the 5-year survival rates for all types of testicular cancer in the United States based on data from the National Cancer Institute’s SEER database:

NSGCTs are a type of testicular cancer that can develop in several germ cell subtypes. Germ cells are the type of cells that produce sperm.

Many NSGCTs contain a mixture of different cell subtypes. Some kinds of NSGCT are more aggressive than others.

Generally, the outlook for people with NSGCT is good, especially for early stage tumors. To get a more specific estimate of your outlook, be sure to have an open conversation with your healthcare team.