American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for patients with stage II nonseminomatous germ cell tumors?

1. Chemotherapy before surgery

2. Retroperitoneal lymph node dissection

3. Only observation

4. High-dose radiation

The correct answer is: Retroperitoneal lymph node dissection

The recommended treatment for patients with stage II nonseminomatous germ cell tumors is retroperitoneal lymph node dissection. This approach is typically indicated for patients with elevated levels of tumor markers or evidence of nodal disease on imaging studies. The rationale behind this treatment is that complete surgical removal of the affected lymph nodes can lead to cure in many patients and allows for accurate staging and treatment planning. While chemotherapy can be an option in certain scenarios, it is generally reserved for patients with more advanced disease or those with poor prognostic indicators. Observation alone is not appropriate in this situation, as it may lead to disease progression and compromise treatment efficacy. High-dose radiation therapy is not a standard treatment for stage II nonseminomatous germ cell tumors as it is more commonly associated with seminomatous tumors and other malignancies.