Testicular cancer staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Testicular cancer may be classified into several subtypes based on TNM system and the American Joint Committee on Cancer (AJCC).

Staging

The American Joint Committee on Cancer (AJCC) includes serum tumor marker levels in the stages for germ cell tumors. Doctors use S to describe the levels of serum tumor markers in the blood after surgery to remove the testicle. The serum tumor markers measured are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH).

Stage 0

Stage	TNM and S	Definition
Stage 0	Tis	Intratubular germ cell neoplasia, unclassified (IGCNU), is present
	N0	No regional lymph node metastasis
	M0	No distant metastasis
	S0	Serum tumor marker levels are normal

Stage I

Stage	TNM and S	Definition
Stage IA	T1	The tumor is only in the testicle and epididymis;tunica albuginea
	N0	No regional lymph node metastasis
	M0	No distant metastasis
	S0	Serum tumor marker levels are normal
Stage IB	T2, T3 or T4	The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels
	N0	No regional lymph node metastasis
	M0	No distant metastasis
	S0	Serum tumor marker levels are normal
Stage IS	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	N0	No regional lymph node metastasis
	M0	No distant metastasis
	S1, S2 or S3	One or more serum tumor markers are higher than normal

Stage II

Stage	TNM and S	Definition
Stage IIA	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	N1	There is regional lymph node metastasis(cancer cells in 1–5 lymph nodes near the testicle; none of the lymph nodes are larger than 2 cm in diameter)
	M0	No distant metastasis
	S0 or S1	Serum tumor marker levels are normal or slightly high
Stage IIB	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	N2	There is regional lymph node metastasis(cancer cells are in one lymph node that is 2–5 cm in diameter; cancer cells are in more than 5 lymph nodes but none of the lymph nodes are larger than 5 cm in diameter); extranodal tumor extension
	M0	No distant metastasis
	S0 or S1	Serum tumor marker levels are normal or slightly high
Stage IIC	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	N3	There is regional lymph node metastasis(the lymph nodes with cancer are larger than 5 cm in diameter)
	M0	No distant metastasis
	S0 or S1	Serum tumor marker levels are normal or slightly high

Stage III

Stage	TNM and S	Definition
Stage IIIA	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	Any N	No regional lymph node metastasis; there is regional lymph node metastasis; extranodal tumor extension
	M1a	There is distant metastasis
	S0 or S1	Serum tumor marker levels are normal or slightly high

Stage	TNM and S	Definition
Stage IIIB	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	N1, N2 or N3	There is regional lymph node metastasis; extranodal tumor extension
	M0	No distant metastasis
	S2	Serum tumor marker levels are high
Stage IIIB	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	Any N	No regional lymph node metastasis; there is regional lymph node metastasis; extranodal tumor extension
	M1a	There is distant metastasis
	S2	Serum tumor marker levels are high

Stage	TNM and S	Definition
Stage IIIC	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	N1, N2 or N3	There is regional lymph node metastasis; extranodal tumor extension
	M0	No distant metastasis
	S3	Serum tumor marker levels are very high
Stage IIIC	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	Any N	No regional lymph node metastasis; there is regional lymph node metastasis; extranodal tumor extension
	M1a	There is distant metastasis
	S3	Serum tumor marker levels are very high
Stage IIIC	Any T	The tumor is in the testicle and epididymis;the tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels;tunica albuginea;tunica vaginalis
	Any N	No regional lymph node metastasis; there is regional lymph node metastasis; extranodal tumor extension
	M1b	There is distant metastasis to an organ other than the lung, such as the liver or a bone
	Any S	Serum tumor marker levels are normal, above normal or very high

References

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