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Testicular cancer (staging)

Changed by Jeremy Jones, 16 Sep 2014
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Updates to Article Attributes

Body was changed:

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 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 foetoproteinfetoprotein : < 1000 ng/mL
    • beta HCG : < 5000 IU/L
    • LDH : < 1.5 x upper limit of normal
  • S2
    • alpha foetoproteinfetoprotein : 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 foetoproteinfetoprotein : > 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
  • -<p>The staging for <a href="/articles/testicular-tumours" title="testicular tumours">testicular tumours</a> is performed according to the <a href="/articles/tnm-staging-system" title="TNM staging system">TNM system</a> with staging groupings. It can be remembered in its abbreviated form as:&#160;</p><ul><li><strong>stage I</strong> :&#160;confined to testis, epididymis, spermatic cord, scrotum</li><li><strong>stage II</strong>&#160;: lymph nodes involved but no distant metastases and serum tumour markers not very high</li><li><strong>stage III</strong>&#160;: distant metastases or very high serum tumour markers</li></ul><h4>TNM staging</h4><h5>T : Tumour</h5><p>Note : Primary tumour staging is from histological assessment following orchiectomy <sup>1-2</sup>. <a name="T_-_Tumour"></a></p><ul><li><strong>Tx</strong>&#160;: primary tumour cannot be assessed (orchidectomy not performed)</li><li><strong>T0</strong>&#160;: no evidence of primary tumour</li><li><strong>Tis&#160;</strong>: intratubular germ cell neoplasia (<a href="../../../../articles/missing?article%5Btitle%5D=carcinoma-in-situ">carcinoma in situ)</a></li><li><strong>T1</strong><ul><li>tumour limited to testis and epididymis</li><li>may invade tunica albuginea</li><li>may NOT invade tunica vaginalis</li><li>no vascular or lymphatic invasion</li></ul></li><li><strong>T2</strong><ul><li>tumour limited to testis and epididymis</li><li>involvement of tunica vaginalis</li><li>vascular or lymphatic invasion</li></ul></li><li><strong>T3</strong>&#160;: invasion of spermatic cord</li><li><strong>T4</strong>&#160;: invasion of scrotum</li></ul><h5>N : Nodes</h5><ul><li><a name="N_-_Nodes"></a><strong>Nx</strong>&#160;: nodes cannot be assessed</li><li><strong>N0</strong>&#160;: no evidence of nodal involvement<br />
  • - </li><li><strong>N1</strong>&#160;: one or more lymph nodes involved but all &lt; 2cm in greatest dimension</li><li><strong>N2</strong>&#160;: one or more lymph nodes involved&#160; 2 - 5 cm in greatest dimension</li><li><strong>N3</strong>&#160;: one or more lymph nodes involved&#160; &gt; 5 cm in greatest dimension</li></ul><h5>M : Metastases</h5><ul><li><a name="M_-_Metastases"></a><strong>Mx</strong>&#160;: presence of metastases cannot be assessed</li><li><strong>M0</strong>&#160;: no evidence of metastases</li><li><strong>M1</strong>&#160;: distant metastases present<ul><li>M1a : non regional lymph node OR pulmonary metastases</li><li>M1b : distant metastases not fulfilling M1a </li></ul></li></ul><h5>S : serum tumour markers</h5><ul><li><strong>Sx</strong>&#160;: no serum tumour markers available</li><li><strong>S0</strong> : within normal limits</li><li><strong>S1</strong><ul><li>alpha foetoprotein : &lt; 1000 ng/mL</li><li>beta HCG : &lt; 5000 IU/L</li><li>LDH : &lt; 1.5 x upper limit of normal</li></ul></li><li><strong>S2</strong><ul><li>alpha foetoprotein : 1,000 - 10,000 ng/mL</li><li>beta HCG : 5,000 - 50,000 IU/L</li><li>LDH : 1.5 - 10 x upper limit of normal</li></ul></li><li><strong>S3</strong><ul><li>alpha foetoprotein : &gt; 10,000 ng/mL</li><li>beta HCG : &gt; 50,000 IU/L</li><li>LDH : &gt; 10 x upper limit of normal</li></ul></li></ul><h4>Stage groupings</h4><ul><li><strong>stage I </strong>: T1–4, N0, M0, SX</li><li><strong>stage II </strong>: any pT/Tx, N1–3, M0, SX<ul><li><strong>IIa</strong> : any pT/Tx, N1, M0, S0 OR any pT/Tx, N1, M0, S1</li><li><strong>IIb</strong> : any pT/Tx, N2, M0, S0 OR any pT/Tx, N2, M0, S1</li><li><strong>IIc</strong> : any pT/Tx, N3, M0, S0 OR any pT/Tx, N3, M0, S1</li></ul></li><li><strong>stage III</strong> : any pT/Tx, any N, M1, SX<ul><li><strong>IIIa</strong> : any pT/Tx, any N, M1a, S0 OR any pT/Tx, any N, M1a, S1</li><li><strong>IIIb</strong> : any pT/Tx, N1–3, M0, S2 OR any pT/Tx, any N, M1a, S2</li><li><strong>IIIc</strong> : any pT/Tx, N1–3, M0, S3 OR any pT/Tx, any N, M1a, S3</li><li>OR any pT/Tx, any N, M1b, any S</li></ul></li></ul>
  • +<p>The staging for <a href="/articles/testicular-tumours">testicular tumours</a> is performed according to the <a href="/articles/tnm-staging-system">TNM system</a> with staging groupings. It can be remembered in its abbreviated form as: </p><ul>
  • +<li>
  • +<strong>stage I</strong>: confined to testis, epididymis, spermatic cord, scrotum</li>
  • +<li>
  • +<strong>stage II</strong>: lymph nodes involved but no distant metastases and serum tumour markers not very high</li>
  • +<li>
  • +<strong>stage III</strong>: distant metastases or very high serum tumour markers</li>
  • +</ul><h4>TNM staging</h4><h5>T: Tumour</h5><p>Primary tumour staging is from histological assessment following orchiectomy <sup>1-2</sup>.</p><ul>
  • +<li>
  • +<strong>Tx</strong>: primary tumour cannot be assessed (orchidectomy not performed)</li>
  • +<li>
  • +<strong>T0</strong>: no evidence of primary tumour</li>
  • +<li>
  • +<strong>Tis</strong>: intratubular germ cell neoplasia (<a href="/articles/missingarticletitlecarcinoma-in-situ">carcinoma in situ)</a>
  • +</li>
  • +<li>
  • +<strong>T1</strong><ul>
  • +<li>tumour limited to testis and epididymis</li>
  • +<li>may invade tunica albuginea</li>
  • +<li>may NOT invade tunica vaginalis</li>
  • +<li>no vascular or lymphatic invasion</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>T2</strong><ul>
  • +<li>tumour limited to testis and epididymis</li>
  • +<li>involvement of tunica vaginalis</li>
  • +<li>vascular or lymphatic invasion</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>T3</strong>: invasion of spermatic cord</li>
  • +<li>
  • +<strong>T4</strong>: invasion of scrotum</li>
  • +</ul><h5>N: Nodes</h5><ul>
  • +<li>
  • +<strong>Nx</strong>: nodes cannot be assessed</li>
  • +<li>
  • +<strong>N0</strong>: no evidence of nodal involvement</li>
  • +<li>
  • +<strong>N1</strong>: one or more lymph nodes involved but all &lt; 2cm in greatest dimension</li>
  • +<li>
  • +<strong>N2</strong>: one or more lymph nodes involved  2 - 5 cm in greatest dimension</li>
  • +<li>
  • +<strong>N3</strong>: one or more lymph nodes involved  &gt; 5 cm in greatest dimension</li>
  • +</ul><h5>M: Metastases</h5><ul>
  • +<li>
  • +<strong>Mx</strong>: presence of metastases cannot be assessed</li>
  • +<li>
  • +<strong>M0</strong>: no evidence of metastases</li>
  • +<li>
  • +<strong>M1</strong>: distant metastases present<ul>
  • +<li>
  • +<strong>M1a:</strong> non regional lymph node OR pulmonary metastases</li>
  • +<li>
  • +<strong>M1b:</strong> distant metastases not fulfilling M1a</li>
  • +</ul>
  • +</li>
  • +</ul><h5>S: serum tumour markers</h5><ul>
  • +<li>
  • +<strong>Sx</strong>: no serum tumour markers available</li>
  • +<li>
  • +<strong>S0</strong>: within normal limits</li>
  • +<li>
  • +<strong>S1</strong><ul>
  • +<li>alpha fetoprotein : &lt; 1000 ng/mL</li>
  • +<li>beta HCG : &lt; 5000 IU/L</li>
  • +<li>LDH : &lt; 1.5 x upper limit of normal</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>S2</strong><ul>
  • +<li>alpha fetoprotein : 1,000 - 10,000 ng/mL</li>
  • +<li>beta HCG : 5,000 - 50,000 IU/L</li>
  • +<li>LDH : 1.5 - 10 x upper limit of normal</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>S3</strong><ul>
  • +<li>alpha fetoprotein : &gt; 10,000 ng/mL</li>
  • +<li>beta HCG : &gt; 50,000 IU/L</li>
  • +<li>LDH : &gt; 10 x upper limit of normal</li>
  • +</ul>
  • +</li>
  • +</ul><h4>Stage groupings</h4><ul>
  • +<li>
  • +<strong>stage I</strong>: T1–4, N0, M0, SX</li>
  • +<li>
  • +<strong>stage II</strong>: any pT/Tx, N1–3, M0, SX<ul>
  • +<li>
  • +<strong>IIa</strong>: any pT/Tx, N1, M0, S0 OR any pT/Tx, N1, M0, S1</li>
  • +<li>
  • +<strong>IIb</strong>: any pT/Tx, N2, M0, S0 OR any pT/Tx, N2, M0, S1</li>
  • +<li>
  • +<strong>IIc</strong>: any pT/Tx, N3, M0, S0 OR any pT/Tx, N3, M0, S1</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>stage III</strong>: any pT/Tx, any N, M1, SX<ul>
  • +<li>
  • +<strong>IIIa</strong>: any pT/Tx, any N, M1a, S0 OR any pT/Tx, any N, M1a, S1</li>
  • +<li>
  • +<strong>IIIb</strong>: any pT/Tx, N1–3, M0, S2 OR any pT/Tx, any N, M1a, S2</li>
  • +<li>
  • +<strong>IIIc</strong>: any pT/Tx, N1–3, M0, S3 OR any pT/Tx, any N, M1a, S3</li>
  • +<li>OR any pT/Tx, any N, M1b, any S</li>
  • +</ul>
  • +</li>
  • +</ul>

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