Objectives
  • To understand the high incidence of germ cell tumours (GCT) at young age

  • To understand the reason for the overall very good prognosis and the importance of chemotherapy

  • To understand the importance of surgery for the primary tumour and for the residual tumours after chemotherapy, which is a standard of care and part of the long-term treatment success

  • To appreciate the differences between seminoma (SGCT) and non-seminomatous NSGCT, and the rare occurrence of extragonadal GCT

  • To understand the diagnostic tools for the detection of the primary tumour and for staging

  • To understand the American Joint Committee on Cancer (AJCC) classification, the role of staging procedures with imaging and the unique role of tumour markers for diagnosis, staging and follow-up of GCT

  • To understand the classification of metastatic patients by the International Germ Cell Cancer Collaborative Group (IGCCCG) and the respective allocation of treatment amount

  • To understand the management options for GCT of stage I and metastatic disease and the importance of treatment according to guidelines for overall outcome

  • To understand that a precancerous lesion (TIN) can be detected by biopsy of the testicle

  • To understand the salvage treatment options for relapse, including high-dose chemotherapy

  • To understand late toxicity of chemotherapy and radiation therapy

Awareness
  • Awareness of the epidemiology and high incidence rate of GCT at young age

  • Recognition that TIN is the precancerous lesion

  • Awareness of the staging tools with imaging and tumour markers

  • Appreciation that GCT are chemotherapy-sensitive and that the introduction of cisplatin is the reason for the high cure rate

  • Awareness of the differences in the management of SGCT and NSGCT

  • Awareness of the roles of chemotherapy, radiation therapy and surgery

  • Recognition that there are also extragonadal GCT

  • Awareness that overall outcome for GCT and, in particular, the high cure rates as well as reduction of late toxicity are linked to treatment according to guidelines and treatment in specialised centres

  • Awareness of late relapse

Knowledge
  • Knowledge of the histological differentiation of GCT, SGCT and NSGCT

  • Understanding that surgery of the primary tumour is standard of care and curative in many stage I patients

  • Knowledge of the indication for contralateral testis biopsy and treatment of TIN

  • Knowledge of the treatment and management options for stage I NSGCT and SGCT and the roles of adjuvant chemotherapy and surveillance

  • Knowledge that metastatic GCT are classified by IGCCCG based on staging with imaging and tumour markers

  • Knowledge of the standard chemotherapy and the strict number of cycles allocated according to the risk classification, and knowledge that there are also other options to be used in special circumstances

  • Knowledge about the correct scheduling in order to guarantee the necessary dose density of chemotherapy

  • Knowledge of the indication for residual tumour surgery after chemotherapy and its curative role, in particular for long-term relapse-free survival

  • Knowledge of the conventional-dose and high-dose (with peripheral stem cell support) chemotherapy regimens in the salvage setting

  • Knowledge of how to handle late relapse

  • Knowledge of the most common late toxicities

Skills
  • Ability to discuss histology and staging with the multidisciplinary tumour board

  • Ability to discuss all aspects of stage I management, surveillance and adjuvant treatment options with patients and their families

  • Ability to interpret tumour marker changes and slopes before, during and after treatment

  • Ability to classify patients with metastases according to the IGCCCG and allocate the correct amount of chemotherapy, thereby respecting the necessary dose density

  • Ability to decide about the indication for postchemotherapy surgery

  • Ability to discuss treatment with chemotherapy and surgery and to explain side effects and potential long-term sequelae

  • Ability to set up an adequate follow-up scheme and to avoid unnecessary radiation risks by imaging