Germ Cell Tumours: Difference between revisions

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** '''FDG-PET'''

*** '''Currently, no role in the routine evaluation of NSGCT and seminoma at the time of diagnosis.'''

~~==== Timing ====~~

* '''Management decisions should be based on imaging studies performed within 4 weeks of the initiation of treatment''' due to the rapid growth of GCTs.

=== Other ===

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**** Studies have shown that expert pathology review can change the pathological subtype in 1-4% of cases.[https://pubmed.ncbi.nlm.nih.gov/16045777/][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704081/]

* '''Management decisions should be based on imaging obtained within the preceding 4 weeks and serum tumor markers (hCG and AFP) within the preceding 10 days.'''

** Due to the rapid ~~doubling time~~ of many GCT, particularly NSGCT, there is a risk of disease progression between staging studies and intervention. Therefore, risk adapted management decisions (i.e. RPLND for Stage IIA disease) should be made based on recent imaging and serum tumor marker levels to avoid undertreatment.

** Due to the rapid growth of many GCT, particularly NSGCT, there is a risk of disease progression between staging studies and intervention. Therefore, risk adapted management decisions (i.e. RPLND for Stage IIA disease) should be made based on recent imaging and serum tumor marker levels to avoid undertreatment.

* '''In patients with normal serum tumor markers (hCG and AFP) and equivocal imaging findings for metastasis, consider repeat imaging in 6-8 weeks to clarify the extent of disease prior to making a treatment recommendation'''.

* '''Prior to definitive management, patients should be counseled about the risks of (3):'''

@@ Line 295: / Line 295: @@
 ** '''<span style="color:#ff0000">FDG-PET</span>'''
 *** '''<span style="color:#ff0000">Currently, no role in the routine evaluation of NSGCT and seminoma at the time of diagnosis.</span>'''
-==== Timing ====
-* '''Management decisions should be based on imaging studies performed within 4 weeks of the initiation of treatment''' due to the rapid growth of GCTs.
 === Other ===
@@ Line 507: / Line 504: @@
 **** Studies have shown that expert pathology review can change the pathological subtype in 1-4% of cases.[https://pubmed.ncbi.nlm.nih.gov/16045777/][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704081/]
 * '''Management decisions should be based on imaging obtained within the preceding 4 weeks and serum tumor markers (hCG and AFP) within the preceding 10 days.'''
-** Due to the rapid doubling time of many GCT, particularly NSGCT, there is a risk of disease progression between staging studies and intervention. Therefore, risk adapted management decisions (i.e. RPLND for Stage IIA disease) should be made based on recent imaging and serum tumor marker levels to avoid undertreatment.
+** Due to the rapid growth of many GCT, particularly NSGCT, there is a risk of disease progression between staging studies and intervention. Therefore, risk adapted management decisions (i.e. RPLND for Stage IIA disease) should be made based on recent imaging and serum tumor marker levels to avoid undertreatment.
 * '''In patients with normal serum tumor markers (hCG and AFP) and equivocal imaging findings for metastasis, consider repeat imaging in 6-8 weeks to clarify the extent of disease prior to making a treatment recommendation'''.
 * '''<span style="color:#ff0000">Prior to definitive management, patients should be counseled about the risks of (3):</span>'''