1. Epidemiology, Staging and Management G. Pentheroudakis University of Ioannina

2. Epidemiology Most common tumour in males 15-35 age group. White (ratio of white to black is approximately 5:1) Incidence 3/100,000 of general population. Lifetime probability: 0.2% Risk factors Cryptorchidism ( Relative risk 8-40) Prior testicular cancer ( Relative risk 25) Genetic (Klinefelter syndrome, Down syndrome, testicular feminization) Carcinoma in situ (intratubular germ cell neoplasia): 50-100% progression to invasive cancer in 10 years. Family history ( Relative risk 10 in brothers, 4 in sons)

4. CIS

5. PLAP immunothistochemistry HE staining

9. WHO British Tumour Panel Seminoma Classical Anaplastic Seminoma Εmbryonal Carcinoma ΜΤ U Choriocarcinoma ΜΤΤ Τeratoma Mature Immature With malignant transformation ΜΤ D Yolk sac tumour Yolk sac tumour Μixed tumours ΜΤΙ

23. Good risk Any HCG AFP 1000 ng/mL Any LDH HCG 5000 mIU/mL Nonpulmonary visceral metastases absent LDH 1.5 upper limit of normal Any primary site Nonpulmonary visceral metastases absent Gonadal or retroperitoneal primary tumor Intermediate risk Nonpulmonary visceral metastases present AFP 1000-10,000 ng/mL Any HCG HCG 5000-50,000 mIU/mL Any LDH LDH 1.5-10.0 upper limit of normal Any primary site Nonpulmonary visceral metastases absent Gonadal or retroperitoneal primary site Poor risk Mediastinal primary site Nonpulmonary visceral metastases present ( eg , bone, liver, brain) AFP 10,000 ng/mL HCG 50,000 mIU/mL SEMINOMAS LDH 10 upper limit of normal NSGCT

24. NSCGT Seminomas Good prognosis 5y OS 92% 5y OS 86% Intermediate prognosis 5y OS 80% 5y OS 73% Poor prognosis 5y OS 48%

27. Fewer testicular new primary tumors with carboplatin

32. PE 500 B 90 x3 PE 500 B 90 x4 No. of patients 88 96 NED after Rx 86 (98%) 93 (97%) Relapse 5 (6%) 5 (5%) Continously NED 81 (92%) 88 (92%)

46. Risk factors are: Presence of CIS and radiotherapy