Editing Germ Cell Tumours (section)

==== Treatment related sequelae ====

* '''Early toxicity'''
** '''Chemotherapy'''
*** '''Cisplatin is associated with fatigue, myelosuppression, infection, peripheral neuropathy, hearing loss, diminished renal function, and death.'''
***'''Etoposide is associated with myelosuppression'''
** '''Radiation'''
*** '''Associated fatigue, nausea and vomiting, leukopenia, and dyspepsia'''
* '''<span style="color:#ff0000">Late toxicity</span>'''
** '''<span style="color:#ff0000">Hypogonadism</span>'''
*** Occurs in
**** 10-20% of patients treated with orchiectomy alone
**** 15-40% of patients treated with radiation therapy
**** 20-25% of patients treated with first-line chemotherapy regimens
*** Serum AM testosterone and luteinizing hormone levels should be measured in patients with signs and symptoms of hypogonadism
** '''<span style="color:#ff0000">Infertility'''
*** Most males are able to have biological children after treatment for GCT but paternity rates are lower for men treated with radiation therapy and/or chemotherapy
** '''<span style="color:#ff0000">Cardiovascular disease</span>'''
*** Risk increased with either subdiaphragmatic radiation or platinum-based chemotherapy
*** Patients should establish regular care with a primary care physician so that modifiable risk factors for cardiovascular disease (e.g., diet, exercise, smoking, serum lipid levels, blood pressure, serum glucose) can be monitored.
** '''<span style="color:#ff0000">Secondary malignancy</span>'''
*** Risk increased with either subdiaphragmatic radiation or platinum-based chemotherapy
*** Patients should establish regular care with a primary care physician for appropriate health care maintenance and cancer screening as appropriate.
** '''<span style="color:#ff0000">Chemotherapy specific'''
*** '''<span style="color:#ff0000">Bleomycin'''
****'''<span style="color:#ff0000">Pulmonary complications (including pulmonary fibrosis)'''
****'''<span style="color:#ff0000">Raynaud phenomenon'''
****'''Mild myelosuppressive effects at high doses.'''
*** '''<span style="color:#ff0000">Cisplatin'''
****'''<span style="color:#ff0000">Nephrotoxicity'''
****'''<span style="color:#ff0000">Neurotoxicity'''
****'''<span style="color:#ff0000">Peripheral neuropathy'''
****'''<span style="color:#ff0000">Hearing loss'''