Embryonal Carcinoma, from the CureRays guide library.

Embryonal carcinoma is an aggressive type of germ-cell cancer, most often found in the testicle, that is highly curable with surgery and cisplatin-based chemotherapy; radiation has only a limited, selective role.

What it is.

Embryonal carcinoma is a kind of germ-cell tumor — a cancer that develops from the cells that would normally form sperm or eggs. It most commonly arises in the testicle in younger men, and far less often in the ovary, chest (mediastinum), or other midline locations. It is one of the more aggressive germ-cell types and is rarely found by itself; it is most often one component of a mixed germ-cell tumor. Despite its aggressive behavior, embryonal carcinoma is highly treatable and usually curable, even when it has spread, because germ-cell cancers respond extremely well to cisplatin-based chemotherapy. Doctors track blood tumor markers — especially beta-hCG and sometimes AFP, along with LDH — which help diagnose the cancer, judge how advanced it is, and monitor the response to treatment. Treatment usually begins with surgery to remove the affected testicle (orchiectomy), followed by chemotherapy when needed and, in some cases, surgery to remove any remaining masses. Unlike the related seminoma, embryonal carcinoma is not very sensitive to radiation, so radiation is used only in selected situations such as treating spread to the brain.

How radiation treats it.

Radiation damages the DNA inside cancer cells so they can no longer divide, while healthy cells repair themselves more effectively. Embryonal carcinoma, unlike the related seminoma, is not very sensitive to radiation, so radiation is not part of routine treatment. Instead, it is used selectively — most often to treat spread to the brain, where focused radiation such as stereotactic radiosurgery can target deposits while sparing surrounding brain tissue, usually in combination with chemotherapy or surgery. When radiation is used, it is delivered as short, painless daily sessions and leaves no radioactivity in your body, so you remain safe to be around family and children. For most patients with embryonal carcinoma, the cure comes from surgery and cisplatin-based chemotherapy rather than radiation.

The ways we can treat it.

Surgery. Removal of the affected testicle (or fertility-sparing ovarian surgery) is the first step, with later surgery to clear residual masses after chemotherapy.

Chemotherapy. Cisplatin-based combinations (such as BEP — bleomycin, etoposide, cisplatin) are the backbone of treatment for spread disease and are highly curative.

Radiation (selective). Because embryonal carcinoma is not very radiosensitive, radiation is reserved for special situations such as treating brain metastases, often alongside surgery or chemotherapy.

Questions we hear often.

Is embryonal carcinoma curable even if it has spread? Yes. Germ-cell cancers, including embryonal carcinoma, are among the most curable cancers even when they have spread, because cisplatin-based chemotherapy is so effective. The large majority of patients are cured, and the outlook is determined by international risk groups based on where the cancer has spread and the blood marker levels.

Why isn't radiation used like it is for seminoma? Seminoma is very sensitive to radiation, but embryonal carcinoma is not, so radiation does not control it well. Instead, chemotherapy is the main treatment for spread disease. Radiation is reserved for special situations, such as treating cancer that has reached the brain.

Will treatment affect my fertility? Treatment can affect fertility, so sperm banking before chemotherapy or surgery is strongly recommended for men, and fertility-sparing surgery is often possible for ovarian tumors. Many people are able to have children after treatment, but discussing fertility preservation with your team beforehand is important.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.