Surgical Management of Testicular Germ Cell Tumors
Sperm banking should be discussed with all patients of reproductive age before undergoing any therapeutic intervention that may compromise fertility, including surgery. Patients receiving testis-sparing surgery (TSS), should be counseled regarding the high risk of local recurrence; the need for continued surveillance with testicular self-exam, physical exam by a physician, and/or ultrasound; the role of adjuvant radiation therapy to reduce the risk of local recurrence; the impact of radiation therapy on sperm and testosterone production; the risk of testicular atrophy; the need for testosterone replacement and possible infertility. Completeness of resection is a consistent independent predictor of clinical outcome. In post-chemotherapy retroperitoneal lymph node dissection (RPLND), surgical margins should not be compromised in an attempt to preserve ejaculation. Additional procedures and resection of adjacent structures may be required. Limited data suggest increased frequency of aberrant recurrences with the use of minimally invasive laparoscopic or robotic approaches to RPLND. A recent study of recurrence patterns in patients following robotic RPLND found that recurrences were highly variable, were in unusual locations, and were associated with a high treatment burden. Therefore, minimally invasive RPLND is not recommended as standard management at this time.
The program is designed to meet the needs and improve the competence and performance of the interprofessional oncology care team, including physicians, nurse practitioners, nurses, physician assistants, pharmacists, and other relevant health care professionals who manage the care of patients with cancer.
Following this program, participants should be able to:
- Describe current surgical management strategies for testicular germ cell tumors.
- Assess the benefits and limitations of current surgical techniques.
- Discuss the supportive care needs that arise during surgical management of testicular germ cell tumors.
Daniel W. Lin, MD
Fred Hutchinson Cancer Research Center/
Seattle Cancer Care Alliance
NCCN Continuing Education Disclosure Policy
It is the policy of NCCN that every 12 months, all faculty, moderators, activity planners and all internal planning staff participating in NCCN continuing education activities are expected to disclose any financial relationships with a commercial interest. In addition, all faculty presentations have been reviewed to ensure education is fair and balanced and that clinical content presented supports safe, effective patient care. Individuals who do not disclose relevant financial relationships will be disqualified from involvement in the CE activity as a content developer, planner, or presenter.
NCCN continuing education considers financial relationships to create a conflict of interest when an individual has both a financial relationship with a commercial interest and the opportunity to affect continuing education content about the products or services of a commercial interest with which he/she has a financial relationship.
NCCN continuing education considers relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. NCCN does not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship.
All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.
Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling.
The faculty listed below discloses the following relevant financial relationships:
Daniel W. Lin, MD
AstraZeneca Pharmaceuticals LP: Scientific Advisor
Clovis Oncology: Scientific Advisor
Lantheus Medical Imaging, Inc.: Scientific Advisor
MagForce USA: Grant/Research Support
MDxHealth, Inc.: Grant/Research Support
National Cancer Institute: Grant/Research Support
The faculty listed below discloses no relevant financial relationships:
Nicholas G. Cost, MD
NCCN Staff Disclosures
The NCCN Leadership listed below discloses no relevant financial relationships:
Robert W. Carlson, MD; Wui-Jin Koh, MD; Gary J. Weyhmuller, MBA, SPHR
The NCCN Activity Planning staff listed below discloses no relevant financial relationships:
Mike Abrams; Melissa Esplen; Mark A. Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Lisa Perfidio, MS; Shannon Ryan, CMP; Kathy Ann Smith, CHCP; Sarah Weinstein
The NCCN Clinical staff listed below discloses no relevant financial relationships:
Susan D. Darlow, PhD; Jennifer Keller, MSS; Lenora Pluchino, PhD
In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
NCCN designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NCCN designates this educational activity for a maximum of 0.75 contact hour.
NCCN designates this application-based continuing education activity for 0.75 contact hour (0.075 CEUs) of continuing education credit. UAN: JA4008196-0000-21-052-H01-P
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credit. Approval is valid until March 1, 2022. PAs should only claim credit commensurate with the extent of their participation.
- 0.75 AAPA Category 1 CME credit
- 0.75 ACPE contact hours
- 0.75 AMA PRA Category 1 Credit™
- 0.75 ANCC contact hours
- 0.75 Participation
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