Metastatic germ cell cancer

This is a case of a patient presenting with extensive metastatic non-seminoma who remains in remission. The classification and prognosis for non-seminoma and the management options for stage I disease are discussed. The chemotherapy options for advanced disease at presentation and for relapsed disease are explored. Issues surrounding acute treatment-related toxicity are considered, particularly lung injury secondary to bleomycin. Given the improvements that have been made, in terms of prognosis, for patients with germ cell cancers, it is essential to consider the potential late effects of treatment. The risk of cardiovascular complications and secondary malignancy are discussed in this context. Some of the current challenges and controversies in advanced disease, such as the management of residual metastatic disease in multiple sites and brain metastases, are also explored.