How would you approach therapy for a patient with non-seminomatous germ cell tumor, cT3N3Mx and symptomatic lower extremity thrombus extending to the IVC when it is unclear if bland or tumor thrombus?
HCG 850, AFP normal, LDH ~500 pre-orchiectomy.
If tumor thrombus, would you favor 4c of BEP? Would you try biopsy it? How common is IVC thrombus with testicular cancer?