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Cancer Staging Systems

Staging of Testicular Cancer

Last Update: Sunday January 4th, 2004 7:15 PM GMT

TNM definition

Primary tumor (T)

The extent of primary tumor is classified after radical orchiectomy, and for this reason, a pathologic stage is assigned.

  • pTX: Primary tumor cannot be assessed*
  • pT0: No evidence of primary tumor (e.g., histologic scar in testis)
  • pTis: Intratubular germ cell neoplasia (carcinoma in situ)
  • pT1: Tumor limited to the testis and epididymis without lymphatic/vascular invasion; tumor may invade into the tunica albuginea but not the tunica vaginalis
  • pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
  • pT3: Tumor invades the spermatic cord with or without vascular/lymphatic invasion
  • pT4: Tumor invades the scrotum with or without vascular/lymphatic invasion

Regional lymph nodes (N)

  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis with a single lymph node mass 2 cm or less in greatest dimension; or multiple lymph nodes, none more than 2 cm in greatest dimension
  • N2: Metastasis with a single lymph node mass more than 2 cm but not more than 5 cm in greatest dimension; or multiple lymph nodes, none more than 5 cm in greatest dimension
  • N3: Metastasis with a lymph node mass more than 5 cm in greatest dimension

Distant metastasis (M)

  • MX: Presence of distant metastasis cannot be assessed
  • M0: No distant metastasis
  • M1: Distant metastasis
    • M1a: Non-regional nodal or pulmonary metastasis
    • M1b: Distant metastasis other than to non-regional lymph nodes and lungs

Serum tumor markers (S)

  • SX: Marker studies not available or not performed
  • S0: Marker study levels within normal limits
  • S1: LDH < 1.5 X N* AND
    • hCG (mIu/ml) < 5000 AND
    • AFP (ng/ml) < 1000
  • S2: LDH 1.5-10 X N* OR
    • hCG (mIu/ml) 5000-50,000 OR
    • AFP (ng/ml) 1000-10,000
  • S3: LDH > 10 X N* OR
    • hCG (mIu/ml) > 50,000 OR
    • AFP (ng/ml) > 10,000

Stage grouping

Stage 0

  • pTis, N0, M0, S0

Stage I

  • pT1-4, N0, M0, SX

Stage IA

  • pT1, N0, M0, S0

Stage IB

  • pT2, N0, M0, S0
  • pT3, N0, M0, S0
  • pT4, N0, M0, S0

Stage IS

  • Any pT/Tx, N0, M0, S1-3

Stage II

  • Any pT/Tx, N1-3, M0, SX

Stage IIA

  • Any pT/Tx, N1, M0, S0
  • Any pT/Tx, N1, M0, S1

Stage IIB

  • Any pT/Tx, N2, M0, S0
  • Any pT/Tx, N2, M0, S1

Stage IIC

  • Any pT/Tx, N3, M0, S0
  • Any pT/Tx, N3, M0, S1

Stage III

  • Any pT/Tx, any N, M1, SX

Stage IIIA

  • Any pT/Tx, any N, M1a, S0
  • Any pT/Tx, any N, M1a, S1

Stage IIIB

  • Any pT/Tx, N1-3, M0, S2
  • Any pT/Tx, any N, M1a, S2

Stage IIIC

  • Any pT/Tx, N1-3, M0, S3
  • Any pT/Tx, any N, M1a, S3
  • Any pT/Tx, any N, M1b, any S

References

  1. Testis. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 317-322.

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