# Testicular Cancer > Testicular cancer for NEET-SS Urology: tumour markers, inguinal orchidectomy, BEP chemotherapy by IGCCCG risk, residual masses and post-chemo RPLND. - Canonical URL: https://prepelephant.com/topics/neet-ss/urology/testicular-cancer-uro - Exam / course: NEET-SS · Subject: Urology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Testicular Cancer", PrepElephant, https://prepelephant.com/topics/neet-ss/urology/testicular-cancer-uro ## Direct answer A painless, firm, non-transilluminating testicular mass in a man of 15 to 35 is a germ cell tumour until excluded — ultrasound first, then inguinal radical orchidectomy with early cord clamping, never a trans-scrotal biopsy, because scrotal violation seeds tumour along a different lymphatic drainage. Markers drawn before surgery — AFP, beta-hCG and LDH — stage the disease alongside CT of chest, abdomen and pelvis: AFP is never raised in pure seminoma, so a raised AFP makes the disease non-seminomatous regardless of histology. Stage I seminoma is managed with surveillance as the preferred option, stage I non-seminoma with surveillance for low risk or surgery or single-cycle chemotherapy for high risk; metastatic disease receives BEP — three cycles for good prognosis, four for intermediate or poor. ## What you must remember - **Markers with meaning:** AFP from yolk sac elements (half-life about five days), beta-hCG from choriocarcinoma and syncytiotrophoblastic seminoma (half-life two to three days), LDH reflecting tumour burden; post-operative decline should follow the half-life, and a plateau means metastatic disease. - **The AFP rule:** a raised AFP in a histological "seminoma" is treated as NSGCT — a one-line exam stem that never ages. - **Stage I seminoma options:** surveillance (preferred in compliant patients), single-dose carboplatin AUC 7, or radiotherapy (historical, rarely chosen now). - **Stage I NSGCT risk split:** no vascular invasion with marker normalisation — surveillance; vascular invasion — retroperitoneal lymph node dissection or one cycle of BEP. - **Chemotherapy:** BEP — bleomycin, etoposide, cisplatin; good prognosis three cycles (or EP for four), intermediate and poor four; bleomycin threatens the lungs, so pulmonary function and smoking status matter before cycle one. - **Residual masses after chemotherapy:** NSGCT residuals above 1 cm need surgical excision, because they harbour teratoma or viable cancer that chemotherapy cannot kill; seminoma residuals are observed unless growing, with PET at about eight weeks guiding the 3 cm-plus residue. - **Fertility:** sperm banking before chemotherapy — counselling is a documented standard, not a courtesy. ## From groin incision to post-chemotherapy masses A 27-year-old notices a painless hard swelling for six weeks; ultrasound shows an intratesticular hypervascular mass. Markers: AFP 240 IU/mL, beta-hCG normal, LDH raised. Through an inguinal incision the cord is clamped, the testis delivered in a swab, and radical orchidectomy completed; histology: mixed germ cell tumour with embryonal carcinoma, vascular invasion present. That AFP already declared the disease non-seminomatous before the pathologist did. Staging CT shows retroperitoneal nodes of 4 cm and two lung nodules — good-prognosis metastatic NSGCT by IGCCCG criteria. Sperm is banked; three cycles of BEP follow, with bleomycin lung fibrosis explained and pulmonary function watched. Markers fall along the half-life curve, and a post-chemotherapy CT leaves a 2.5 cm retroperitoneal residue: excise it — the specimen may be necrosis, teratoma or viable tumour, and only resection of teratoma prevents the late, chemotherapy-resistant relapse. Had the histology been pure seminoma with a 2 cm residue, the same CT would be watched, with PET at eight weeks deciding intervention. ## Where the exam sets its traps The incision is the first trap: any option containing "trans-scrotal biopsy" is wrong, and the follow-up viva asks what scrotal violation costs — altered lymphatic fields, local recurrence, additional scrotal resection. The second is marker logic: "AFP raised, biopsy reports seminoma — next step?" — treat as NSGCT. The third is the residual mass: post-BEP 3 cm residual in NSGCT means surgery, not more chemotherapy; the same size residue in seminoma means observation with PET. The fourth is the emergency presentation: choriocarcinoma metastases bleed, and the haemoptysis or intracranial bleed stem expects chemotherapy started urgently rather than biopsy first. And the counselling mark: a 25-year-old about to start BEP is asked about fertility — the candidate who forgets sperm banking loses a mark that takes five seconds to earn. ## Frequently asked questions ### Why is orchidectomy inguinal rather than trans-scrotal? The testis drains to para-aortic nodes; scrotal skin drains to inguinal nodes, so a scrotal incision violates compartments and risks local recurrence and inguinal spread. Inguinal radical orchidectomy with early cord clamping also limits tumour spill. ### What does a raised AFP in an apparent seminoma signify? Pure seminoma never raises AFP, so the tumour harbours non-seminomatous elements and is managed as NSGCT — marker-based staging, chemotherapy decisions and residual-mass surgery included. ### How is stage I seminoma managed after orchidectomy? Surveillance is preferred for compliant patients; single-dose carboplatin AUC 7 and, historically, para-aortic radiotherapy are alternatives. All approaches preserve near-normal cancer-specific survival. ### How many BEP cycles, and by what rule? Three cycles for good-prognosis metastatic disease (or four of EP), four for intermediate- and poor-prognosis disease per IGCCCG. Good prognosis requires a testis primary, no non-pulmonary visceral metastases, and markers below AFP 1000, hCG 5000 and LDH 1.5 times the upper limit. ### Why excise a residual mass after chemotherapy for NSGCT? Residual tissue over 1 cm may be necrosis, teratoma or viable malignancy, and neither teratoma nor resistant tumour responds to further chemotherapy. Surgical excision prevents late relapse and clarifies prognosis.