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 are not very high
  • stage III: distant metastases or moderately high serum tumour markers

TNM staging

T: Tumour

Primary tumour staging is from histological assessment following orchidectomy 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

Abdominal retroperitoneal nodes are considered regional lymph nodes. A CT short axis measurement threshold of 7-8 mm has 70% sensitivity and specificity for malignant involvement or retroperitoneal nodes 4. The largest dimension of a lymph node is used to differentiate between N1-N3.

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

Most men with nonseminomatous germ cell tumour have elevated serum beta hCG and alpha fetoprotein (AFP). For men with seminomas, beta hCG is elevated only in a minority and AFP level are almost always normal 5.

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

Serologic markers are often used to monitor treatment and/or detect recurrence.

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
Share Article

Article Information

rID: 2158
System: Urogenital
Section: Staging
Tags: testis, staging
Synonyms or Alternate Spellings:
  • Staging of testicular cancer

Support Radiopaedia to see fewer ads

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.