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Testicular cancer staging

Dr Frank Gaillard et al.

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

stage I : confined to testis, epididymis, spermatic cord, scrotum
stage II : lymph nodes involved but no distant metastases and serum tumour markers not very high
stage III : distant metastases or very high serum tumour markers

TNM staging

T : Tumour

Note : Primary tumour staging is from histological assessment following orchiectomy ^1-2.

Tx : primary tumour cannot be assessed (orchidectomy not performed)
T0 : no evidence of primary tumour
Tis : intratubular germ cell neoplasia (carcinoma in situ)
T1
- tumour limited to testis and epididymis
- may invade tunica albuginea
- may NOT invade tunica vaginalis
- no vascular or lymphatic invasion
T2
- tumour limited to testis and epididymis
- involvement of tunica vaginalis
- vascular or lymphatic invasion
T3 : invasion of spermatic cord
T4 : invasion of scrotum

N : Nodes

Nx : nodes cannot be assessed
N0 : no evidence of nodal involvement
N1 : one or more lymph nodes involved but all < 2cm 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

M : Metastases

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

S : serum tumour markers

Sx : no serum tumour markers available
S0 : within normal limits
S1
- alpha foetoprotein : < 1000 ng/mL
- beta HCG : < 5000 IU/L
- LDH : < 1.5 x upper limit of normal
S2
- alpha foetoprotein : 1,000 - 10,000 ng/mL
- beta HCG : 5,000 - 50,000 IU/L
- LDH : 1.5 - 10 x upper limit of normal
S3
- alpha foetoprotein : > 10,000 ng/mL
- beta HCG : > 50,000 IU/L
- LDH : > 10 x upper limit of normal

Stage groupings

stage I : T1–4, N0, M0, SX
stage II : any pT/Tx, N1–3, M0, SX
- IIa : any pT/Tx, N1, M0, S0 OR any pT/Tx, N1, M0, S1
- IIb : any pT/Tx, N2, M0, S0 OR any pT/Tx, N2, M0, S1
- IIc : any pT/Tx, N3, M0, S0 OR any pT/Tx, N3, M0, S1
stage III : any pT/Tx, any N, M1, SX
- IIIa : any pT/Tx, any N, M1a, S0 OR any pT/Tx, any N, M1a, S1
- IIIb : any pT/Tx, N1–3, M0, S2 OR any pT/Tx, any N, M1a, S2
- IIIc : any pT/Tx, N1–3, M0, S3 OR any pT/Tx, any N, M1a, S3
- OR any pT/Tx, any N, M1b, any S