Testicular Cancer
Testicular germ cell tumours are notable for their sensitivity to systemic therapy and for the central role serum tumour markers play in diagnosis, risk stratification and monitoring.
Disease categories
Major disease categories
- Seminoma
- Non-seminomatous germ cell tumours
- Mixed germ cell tumours
- Extragonadal germ cell tumours
Molecular
Molecular considerations
Isochromosome 12p is characteristic of germ cell tumours. Serum markers are integral to management discussion.
Markers commonly discussed in testicular cancer
- AFP
- β-hCG
- LDH
- i(12p)
Not exhaustive, and not every marker is assessed in every patient. Which of these is relevant depends on the individual case and should be discussed with the treating team.
Testing
Genomic testing considerations
Molecular profiling has a limited routine role; it is discussed in refractory disease.
Germline
Germline considerations
Considered where family history is suggestive.
Molecular monitoring
ctDNA and liquid biopsy considerations
Investigational. MicroRNA markers are an area of research interest.
Single-cell & computation
Single-cell and algorithmic approaches
Single-cell sequencing in genitourinary cancer is used to characterise lineage plasticity — particularly the transition towards neuroendocrine phenotype, which is a cell-state change that bulk profiling can miss entirely. Single-cell DNA analysis addresses clonal structure across metastatic sites, which is frequently discordant. Algorithm work includes DNA damage repair pathway scoring, resistance-alteration detection from serial plasma, and models that integrate imaging and molecular trajectories.
Decisions
Treatment decision questions
Questions worth raising with a treating team when a decision is being made:
- Are serum markers documented with their timing relative to treatment?
- Is the histology, including any non-seminomatous component, clearly established?
Resistance
Resistance and recurrence questions
- Has growing teratoma syndrome been considered where masses enlarge with normal markers?
Trials
Clinical trial considerations
Relevant chiefly in refractory disease.
When a precision oncology review may help
A review is most useful where the standard pathway has been exhausted or where the picture is more complicated than a protocol accounts for — rare presentations, treatment resistance, complex or apparently contradictory molecular findings, or a decision between several defensible options.
The output is a structured analysis and a set of questions for the treating team. It is not treatment, and it does not replace the treating oncologist.