Stage I germ cell cancers
Stage I seminomas are usually treated with radical inguinal orchiectomy (surgical removal of the testicle and spermatic cord) followed by radiation aimed at regional lymph nodes (inguinal and retroperitoneal nodes). More than 95 percent of Stage I seminomas can be cured this way.

Stage I nonseminoma germ cell cancers are also highly curable, but the standard approach is radical inguinal orchiectomy. In adults, controversy remains over additional treatments. The standard approach is for patients to undergo a RPLND or removal of regional lymph nodes. Alternatively, patients may be treated with two cycles of chemotherapy or be followed by close observation, with chemotherapy initiated at the first sign of relapse. Decisions on these alternative approaches for patients must be made on an inidvidual basis by the patient and his treating physician.

Stage II germ cell cancers
Stage II seminomas are classified as "bulky" or "nonbulky," depending on their mass. Nonbulky cancer is treated with radical inguinal orchiectomy followed by radiation to the regional (retroperitoneal) lymph nodes. Men with bulky tumors undergo radical inguinal orchiectomy, after which they either undergo radiation therapy of retroperitoneal nodes as well as the more distant abdominal and pelvic nodes, or begin a course of combination chemotherapy that includes cisplatin.

Standard treatment for Stage II nonseminoma germ cell tumors is radical inguinal orchiectomy and retroperitoneal lymph node removal. If the cancer has spread to five or fewer lymph nodes, chemotherapy is not necessary. However, chemotherapy may begin if a relapse occurs or if follow-up exams show that certain protein levels have not returned to normal. Usually, chemotherapy results in cure at this point. Sometimes, chemotherapy begins immediately after surgical removal of the testicle and lymph nodes. Men whose disease involves lymph node masses so large they cannot be effectively removed usually undergo radical inguinal orchiectomy followed by chemotherapy.

Stage II seminomas and nonseminoma germ cell cancers can be cured in 90 to 95 percent of cases.

Stage III germ cell cancers
Stage III seminomas are treated with surgery followed by chemotherapy. This approach produces a cure in more than 70 percent of cases. Patients whose cancer has spread to the brain usually receive chemotherapy plus radiation therapy aimed at the brain.

Stage III nonseminomas and seminomas usually receive the same treatment and have similar survival rates.

Recurrent germ cell cancer
Regional node recurrence after surgery for early stage tumors can be treated with radiation or surgery. If the cancer has recurred at a distant organ after chemotherapy, different drug combinations may be tried.