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Testicular cancer staging

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

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