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Kevin M. Elias, Ross S. Berkowitz and Neil S. Horowitz

particularly high human chorionic gonadotropin (hCG) levels and excessive uterine size. In recent years, CHM is more commonly diagnosed earlier in the first trimester, and these dramatic signs and symptoms are much less frequent. 8 – 11 Although excessive

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Robert J. Motzer, Neeraj Agarwal, Clair Beard, Sam Bhayani, Graeme B. Bolger, Mark K. Buyyounouski, Michael A. Carducci, Sam S. Chang, Toni K. Choueiri, Shilpa Gupta, Steven L. Hancock, Gary R. Hudes, Eric Jonasch, Timothy M. Kuzel, Clayton Lau, Ellis G. Levine, Daniel W. Lin, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Thomas W. Ratliff, Bruce G. Redman, Cary N. Robertson, Charles J. Ryan, Joel Sheinfeld, Jue Wang and Richard B. Wilder

, such as sarcoma or adenocarcinoma, and is then referred to as a teratoma with malignant transformation. The serum tumor markers alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and β-human chorionic gonadotropin (β-HCG) are critical in diagnosing

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Robert J. Motzer, Neeraj Agarwal, Clair Beard, Graeme B. Bolger, Barry Boston, Michael A. Carducci, Toni K. Choueiri, Robert A. Figlin, Mayer Fishman, Steven L. Hancock, Gary R. Hudes, Eric Jonasch, Anne Kessinger, Timothy M. Kuzel, Paul H. Lange, Ellis G. Levine, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Bruce G. Redman, Cary N. Robertson, Lawrence H. Schwartz, Joel Sheinfeld and Jue Wang

Testicular Cancer Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview An estimated 8090 new cases of testicular cancer will be diagnosed in the United States in 2008.1 Germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes. These tumors also occur occasionally in extragonadal primary sites, but they are still managed the same as testicular GCTs. Although GCTs are relatively uncommon tumors that comprise only 2% of all human malignancies, they constitute the most common solid tumor in men between the ages of 15 and 34 years. In addition, the worldwide incidence of these tumors has more than doubled in the past 40 years. Several risk factors for GCT development have been identified, including prior history, positive family history, cryptorchidism, testicular dysgenesis, and Klinefelter's syndrome. GCTs are classified as seminoma or nonseminoma. Nonseminomatous tumors often include multiple cell types, including embryonal cell...
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Nadeem R. Abu-Rustum, Catheryn M. Yashar, Sarah Bean, Kristin Bradley, Susana M. Campos, Hye Sook Chon, Christina Chu, David Cohn, Marta Ann Crispens, Shari Damast, Oliver Dorigo, Patricia J. Eifel, Christine M. Fisher, Peter Frederick, David K. Gaffney, Ernest Han, Warner K. Huh, John R. Lurain III, Andrea Mariani, David Mutch, Christa Nagel, Larissa Nekhlyudov, Amanda Nickles Fader, Steven W. Remmenga, R. Kevin Reynolds, Rachel Sisodia, Todd Tillmanns, Stefanie Ueda, Emily Wyse, Nicole R. McMillian and Jillian Scavone

moles metastasize to the lung or vagina. Persistent elevated human chorionic gonadotropin (hCG) after evacuation of a molar pregnancy most often leads to the diagnosis of invasive mole. 2 Choriocarcinoma develops from villous trophoblast. Features of

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David S. Ettinger, Wallace Akerley, Gerold Bepler, Matthew G. Blum, Andrew Chang, Richard T. Cheney, Lucian R. Chirieac, Thomas A. D'Amico, Todd L. Demmy, Ramaswamy Govindan, Frederic W. Grannis Jr., Thierry Jahan, David H. Johnson, Anne Kessinger, Ritsuko Komaki, Feng-Ming Kong, Mark G. Kris, Lee M. Krug, Quynh-Thu Le, Inga T. Lennes, Renato Martins, Janis O'Malley, Raymond U. Osarogiagbon, Gregory A. Otterson, Jyoti D. Patel, Katherine M. Pisters, Karen Reckamp, Gregory J. Riely, Eric Rohren, Scott J. Swanson, Douglas E. Wood and Stephen C. Yang

function tests and MRI of the chest can also be done if clinically indicated. On CT, thymoma can look like malignant mesothelioma; however, pleural effusion does not typically occur with thymoma. Alpha-fetoprotein (AFP) and β–human chorionic gonadotropin

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Sajeel Chowdhary and Marc Chamberlain

. 34 Fujimaki T Mishima K Asai A . Levels of beta-human chorionic gonadotropin in cerebrospinal fluid of patients with malignant germ cell tumor can be used to detect early recurrence and monitor the response to treatment . Jpn J Clin Oncol 2000

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Annika M. Gustafson, Deborah J. Goldfrank, William A. Dunson, Daniel L. Mulkerin, Rebecca L. Caires and Keith D. Eaton

None of these approaches is perfect. Screening questions in a medical history may alert a provider about a risk for pregnancy, but the questions have low sensitivity and specificity for detection. Blood serum human chorionic gonadotropin (hCG) testing

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Apostolia M. Tsimberidou, Alexandra M. Adamopoulos, Yang Ye, Sarina Piha-Paul, Filip Janku, Siqing Fu, David Hong, Gerald S. Falchook, Aung Naing, Jennifer Wheler, Adoneca Fortier, Razelle Kurzrock and Kenneth R. Hess

3 weeks from targeted or biologic therapy, whichever was shorter. All female patients of childbearing age had to have a negative human chorionic gonadotropin urine test. Exclusion criteria were pregnancy; active bleeding; active gastric or duodenal

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Timothy Gilligan, Daniel W. Lin, Rahul Aggarwal, David Chism, Nicholas Cost, Ithaar H. Derweesh, Hamid Emamekhoo, Darren R. Feldman, Daniel M. Geynisman, Steven L. Hancock, Chad LaGrange, Ellis G. Levine, Thomas Longo, Will Lowrance, Bradley McGregor, Paul Monk, Joel Picus, Phillip Pierorazio, Soroush Rais-Bahrami, Philip Saylor, Kanishka Sircar, David C. Smith, Katherine Tzou, Daniel Vaena, David Vaughn, Kosj Yamoah, Jonathan Yamzon, Alyse Johnson-Chilla, Jennifer Keller and Lenora A. Pluchino

nonseminomas are typically managed using surveillance. The serum tumor markers alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) are critical in determining prognosis and assessing treatment outcomes in patients with testicular GCTs

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Linda A. Jacobs and David J. Vaughn

chorionic gonadotropin–secreting tumor. 22 After unilateral orchiectomy, at a median of 5 months of follow-up, serum testosterone levels are usually similar to preorchiectomy levels, although LH is increased. 23 The increase in LH is compensatory and