Scrotal mass staging TNM: Difference between revisions

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==Overview==
==Overview==
According to the TNM classification and stage groupings, there are 3 stages of testicular cancer based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.<ref name=stagingofgermcelltumoiukjrsg>Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 29, 2016</ref>


==Staging==
==Staging==
The staging for testicular cancer is performed according to the '''TNM system''' with stage groupings. It can be remembered in its abbreviated form as:<ref name=testiculartumorstGING1>Testicular cancer staging. Dr Marcin Czarniecki and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-cancer-staging. Accessed on February 26, 2016</ref>
*'''Stage I''': confined to testis, epididymis, spermatic cord, scrotum
*'''Stage II''': lymph nodes involved but no distant metastases, and serum tumor markers are not very high
*'''Stage III''': distant metastases or moderately high serum tumor markers


The American Joint Committee on Cancer (AJCC) includes [[tumor marker|serum tumor marker levels]] in the stages for [[germ cell tumor|testicular germ cell tumors]]. '''S''' describes the levels of serum tumor markers in the blood after [[orchiectomy]]. The serum tumor markers measured are [[AFP|alpha-fetoprotein (AFP)]], [[HCG|human chorionic gonadotropin (HCG)]], and [[LDH|lactate dehydrogenase (LDH)]].<ref name=stagingofgermcelltumors1>Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 26, 2016</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:1000px"
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|S}}
! style="background: #4479BA; width: 800px;" | {{fontcolor|#FFF|Serum tumor marker levels}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |SX
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor marker levels are not available or have not been measured.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor marker levels are normal.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center |S1
| style="padding: 5px 5px; background: #F5F5F5;" |All tumor marker levels are above normal.
*AFP is less than 1,000 ng/mL.
*HCG is less than 5,000 mIU/mL.
*LDH is less than 1.5 times the upper limit of the normal range.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center|S2
| style="padding: 5px 5px; background: #F5F5F5;" |At least one [[tumor marker|tumor marker level]] is high.
*[[AFP]] is between 1,000 and 10,000 ng/mL.
*[[HCG]] is between 5,000 and 50,000 mIU/mL.
*[[LDH]] is 1.5–10 times the upper limit of the normal range.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center|S3
| style="padding: 5px 5px; background: #F5F5F5;" |At least one tumor marker level is very high.
*AFP is higher than 10,000 ng/mL.
*HCG is higher than 50,000 mIU/mL.
*LDH is more than 10 times the upper limit of the normal range.
|}
===TNM Classification for Testicular Cancer===
'''TNM''' stands for tumor, nodes, and metastasis. TNM staging describes:<ref name=testiculartumorstGING1>Testicular cancer staging. Dr Marcin Czarniecki and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-cancer-staging. Accessed on February 26, 2016</ref>
*size and extent of the primary tumor
*number and location of any regional lymph nodes (abdominal retroperitoneal nodes) infiltrated by tumor cells
*whether the cancer metastasized to distant part of the body
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|TNM Classification}}
! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF|Primary Tumor (T)}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |TX
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed ([[orchiectomy]] not performed)
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center|T0
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of primary tumor
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Tis
| style="padding: 5px 5px; background: #F5F5F5;" |Intratubular germ cell neoplasia (''carcinoma in situ'')
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T1
| style="padding: 5px 5px; background: #F5F5F5;" |
Tumor limited to [[testis]] and [[epididymis]]<br>
May invade [[tunica albuginea]]<br>
May NOT invade [[tunica vaginalis]]<br>
No vascular or lymphatic invasion
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T2
| style="padding: 5px 5px; background: #F5F5F5;" |
Tumor limited to [[testis]] and [[epididymis]]<br>
Involvement of [[tunica vaginalis]]<br>
Vascular or lymphatic invasion
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T3
| style="padding: 5px 5px; background: #F5F5F5;" |Invasion of the [[spermatic cord]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T4
| style="padding: 5px 5px; background: #F5F5F5;" |Invasion of the [[scrotum]]
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF|Regional Lymph Nodes (N)}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |NX
| style="padding: 5px 5px; background: #F5F5F5;" |Regional lymph nodes cannot be assessed
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N0
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of nodal involvement
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N1
| style="padding: 5px 5px; background: #F5F5F5;" |One or more lymph nodes involved, but all <2 cm in greatest dimension
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N2
| style="padding: 5px 5px; background: #F5F5F5;" |One or more lymph nodes involved 2-5 cm in greatest dimension
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N3
| style="padding: 5px 5px; background: #F5F5F5;" |One or more lymph nodes involved >5 cm in greatest dimension
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF| Distant Metastasis (M)}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |MX
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of metastases cannot be assessed
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of metastases
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |M1
| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis|metastases]] present
*'''M1a''': non-regional lymph node OR pulmonary metastases
*'''M1b''': distant metastases not fulfilling M1a
|}


==References==
==References==
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Latest revision as of 16:35, 27 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

According to the TNM classification and stage groupings, there are 3 stages of testicular cancer based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.[1]

Staging

The staging for testicular cancer is performed according to the TNM system with stage groupings. It can be remembered in its abbreviated form as:[2]

  • Stage I: confined to testis, epididymis, spermatic cord, scrotum
  • Stage II: lymph nodes involved but no distant metastases, and serum tumor markers are not very high
  • Stage III: distant metastases or moderately high serum tumor markers

The American Joint Committee on Cancer (AJCC) includes serum tumor marker levels in the stages for testicular germ cell tumors. S describes the levels of serum tumor markers in the blood after orchiectomy. The serum tumor markers measured are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH).[3]

S Serum tumor marker levels
SX Tumor marker levels are not available or have not been measured.
S0 Tumor marker levels are normal.
S1 All tumor marker levels are above normal.
  • AFP is less than 1,000 ng/mL.
  • HCG is less than 5,000 mIU/mL.
  • LDH is less than 1.5 times the upper limit of the normal range.
S2 At least one tumor marker level is high.
  • AFP is between 1,000 and 10,000 ng/mL.
  • HCG is between 5,000 and 50,000 mIU/mL.
  • LDH is 1.5–10 times the upper limit of the normal range.
S3 At least one tumor marker level is very high.
  • AFP is higher than 10,000 ng/mL.
  • HCG is higher than 50,000 mIU/mL.
  • LDH is more than 10 times the upper limit of the normal range.

TNM Classification for Testicular Cancer

TNM stands for tumor, nodes, and metastasis. TNM staging describes:[2]

  • size and extent of the primary tumor
  • number and location of any regional lymph nodes (abdominal retroperitoneal nodes) infiltrated by tumor cells
  • whether the cancer metastasized to distant part of the body
TNM Classification Definition
Primary Tumor (T)
TX Primary tumor cannot be assessed (orchiectomy not performed)
T0 No evidence of primary tumor
Tis Intratubular germ cell neoplasia (carcinoma in situ)
T1

Tumor limited to testis and epididymis
May invade tunica albuginea
May NOT invade tunica vaginalis
No vascular or lymphatic invasion

T2

Tumor limited to testis and epididymis
Involvement of tunica vaginalis
Vascular or lymphatic invasion

T3 Invasion of the spermatic cord
T4 Invasion of the scrotum
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No evidence of nodal involvement
N1 One or more lymph nodes involved, but all <2 cm in greatest dimension
N2 One or more lymph nodes involved 2-5 cm in greatest dimension
N3 One or more lymph nodes involved >5 cm in greatest dimension
Distant Metastasis (M)
MX Presence of metastases cannot be assessed
M0 No evidence of metastases
M1 Distant metastases present
  • M1a: non-regional lymph node OR pulmonary metastases
  • M1b: distant metastases not fulfilling M1a

References

  1. ↑ Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 29, 2016
  2. ↑ 2.0 2.1 Testicular cancer staging. Dr Marcin Czarniecki and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-cancer-staging. Accessed on February 26, 2016
  3. ↑ Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 26, 2016


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