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Stage Information for Testicular Cancer

(continued)

continued...

Table 3. Distant Metastasis (M)a

^a Reprinted with permission from AJCC: Testis. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 469-78.
M0	No distant metastasis.
M1	Distant metastasis.
M1a	Nonregional nodal or pulmonary metastasis.
M1b	Distant metastasis other than to nonregional lymph nodes and lung.

Table 4. Anatomic Stage/Prognostic Groupsa

^a Reprinted with permission from AJCC: Testis. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 469-78.
Group	T	N	M	S (Serum Tumor Markers)
0	pTis	N0	M0	S0
I	pT1-4	N0	M0	SX
IA	pT1	N0	M0	S0
IB	pT2	N0	M0	S0
pT3	N0	M0	S0
pT4	N0	M0	S0
IS	Any pT/Tx	N0	M0	S1-3
II	Any pT/Tx	N1-3	M0	SX
IIA	Any pT/Tx	N1	M0	S0
Any pT/Tx	N1	M0	S1
IIB	Any pT/Tx	N2	M0	S0
Any pT/Tx	N2	M0	S1
IIC	Any pT/Tx	N3	M0	S0
Any pT/Tx	N3	M0	S1
III	Any pT/Tx	Any N	M1	SX
IIIA	Any pT/Tx	Any N	M1a	S0
Any pT/Tx	Any N	M1a	S1
IIIB	Any pT/Tx	N1-3	M0	S2
Any pT/Tx	Any N	M1a	S2
IIIC	Any pT/Tx	N1-3	M0	S3
Any pT/Tx	Any N	M1a	S3
Any pT/Tx	Any N	M1b	Any S

Table 5. Site-Specific Prognostic Factorsa

^a Reprinted with permission from AJCC: Testis. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 469-78.
^b AFP = alpha-fetoprotein; hCG = human chorionic gonadotropin; LDH = lactase dehydrogenase; N indicates the upper limit of normal for the LDH assay.
Serum Tumor Markers (S) Required for Staging
SX	Marker studies not available or not performed.
S0	Marker study levels within normal limits.
S1	LDH <1.5 � N^band hCG (mIu/ml) <5,000 and AFP (ng/ml) <1,000.
S2	LDH 1.5-10 � N or hCG (mIu/ml) 5,000-50,000 or AFP (ng/ml) 1,000-10,000.
S3	LDH >10 � N or hCG (mIu/ml) >50,000 or AFP (ng/ml) >10,000.

In addition to the clinical stage definitions, surgical stage may be designated based on the results of surgical removal and microscopic examination of tissue.

Stage I

Stage I testicular cancer is limited to the testis. Invasion of the scrotal wall by tumor or interruption of the scrotal wall by previous surgery does not change the stage but does increase the risk of spread to the inguinal lymph nodes, and this must be considered in treatment and follow-up. Invasion of the epididymis tunica albuginea and/or the rete testis does not change the stage. Invasion of the tunica vaginalis or lymphovascular invasion signifies a T2 tumor, while invasion of the spermatic cord signifies a T3 tumor, and invasion of the scrotum signifies a T4. Increases in T stage are associated with increased risk of occult metastatic disease and recurrence. Men with stage I disease who have persistently elevated serum tumor markers after orchiectomy are staged as IS, but stage IS nonseminomas are treated as stage III. Elevated serum tumor markers in stage I or II seminoma are of unclear significance except that a persistently elevated or rising hCG usually indicates metastatic disease.

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Last Updated: May 16, 2012

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