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Cancer Staging Systems

Staging of Testicular Cancer

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

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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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