Testicular cancer staging
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]
Diagnostic Study of Choice
Diagnostic Study of Choice
- The diagnostic study of choice for testicular cancer is scrotal ultrasound.[1][2][3]
Staging
Staging
- Testicular cancer may be classified into several subtypes based on the TNM system and the American Joint Committee on Cancer (AJCC).
The American Joint Committee on Cancer (AJCC) includes serum tumor marker levels in the stages for germ cell tumors. Doctors use S to describe the levels of serum tumor markers in the blood after surgery to remove the testicle. The serum tumor markers measured are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH).[4]
| Stage | TNM/S | Description |
|---|---|---|
| Stage 0 | pTisb | Germ cell neoplasia in situ |
| N0 | cNO No regional lymph node metastasis | |
| N0 | pNO No regional lymph node metastasis | |
| M0 | No distant metastasis | |
| SO | SO Marker study levels within normal limits | |
| Stage I | pT1 | Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. |
| pT1ab | Tumor <3 cm in size | |
| pT1bb | Tumor ≥3 cm in size | |
| pT2 | Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. | |
| pT3 | Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | |
| pT4 | Tumor invades scrotum with or without lymphovascular invasion. | |
| cNO | No regional lymph node metastasis. | |
| pNO | No regional lymph node metastasis. | |
| MO | No distant metastasis. | |
| SX | Marker studies not available or not performed. | |
| Stage IA | pT1 | Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. |
| pT1aa | Tumor <3 cm in size | |
| pT1bb | Tumor ≥3 cm in size | |
| cNO | No regional lymph node metastasis. | |
| pNO | No regional lymph node metastasis. | |
| MO | No distant metastasis. | |
| S0 | Marker study levels within normal limits. | |
| Stage IB | pT2 | Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. |
| cN0 | No regional lymph node metastasis | |
| pN0 | No regional lymph node metastasis | |
| M0 | No distant metastasis | |
| S0 | Marker study levels within normal limits. | |
| pT3 | Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | |
| cN0 | No regional lymph node metastasis | |
| pN0 | No regional lymph node metastasis | |
| M0 | No distant metastasis | |
| S0 | Marker study levels within normal limits. | |
| pT4 | Tumor invades scrotum with or without lymphovascular invasion. | |
| cN0 | No regional lymph node metastasis | |
| pN0 | No regional lymph node metastasis | |
| M0 | No distant metastasis | |
| S0 | Marker study levels within normal limits. | |
| Stage IS | pTX | Primary tumor cannot be assessed. |
| pT0 | No evidence of primary tumor. | |
| pTis | Germ cell neoplasia in situ. | |
| pT1 | Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. | |
| pT1ab | Tumor 3 cm in size. | |
| pT1bb | Tumor ≥3 cm in size. | |
| pT2 | Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. | |
| pT3 | Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | |
| pT4 | Tumor invades scrotum with or without lymphovascular invasion. | |
| cN0 | No regional lymph node metastasis. | |
| pN0 | No regional lymph node metastasis. | |
| M0 | No distant metastasis | |
| S1 | LDH < 1.5 × Nc and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
| S2 | LDH 1.5–10 × Nc or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
| S3 | LDH > 10 × Nc or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |
| Stage II | Any pT/TX | Primary tumor cannot be assessed/Marker studies not available or not performed. |
| cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
| cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
| cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
| pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
| pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| M0 | No distant metastases. | |
| SX | Marker studies not available or not performed. | |
| Stage IIA | Any pT/TX | Primary tumor cannot be assessed/Marker studies not available or not performed. |
| cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
| pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
| M0 | No distant metastasis | |
| S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
| Stage IIB | Any pT/TX | See above description. |
| cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
| pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
| M0 | No distant metastases. | |
| S0 | Marker study levels within normal limits. | |
| pT/TX | See above description | |
| cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
| pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
| M0 | No distant metastases. | |
| S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
| Stage IIC | Any pT/TX | See above description. |
| cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| M0 | No distant metastases. | |
| S0 | Marker study levels within normal limits. | |
| Any pT/TX | See above description. | |
| cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| M0 | No distant metastasis | |
| S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
| Stage III | Any pT/TX | See above description. |
| cNX | Regional lymph nodes cannot be assessed. | |
| cN0 | No regional lymph node metastasis. | |
| cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
| cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
| cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| pNX | Regional lymph nodes cannot be assessed. | |
| pN0 | No regional lymph node metastasis. | |
| pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
| pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
| pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| M1 | Distant metastases. | |
| M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
| M1b | Nonpulmonary visceral metastases. | |
| SX | Marker studies not available or not performed. | |
| Stage IIIA | Any pT/TX | See above description. |
| Any N | See descriptions in this table, Stage III. | |
| M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
| S0 | Marker study levels within normal limits. | |
| Any pT/TX | See above description. | |
| Any N | See descriptions in this table, Stage III. | |
| M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
| S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
| Stage IIIB | Any pT/TX | See above descriptions |
| cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
| cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
| cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
| pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
| pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| M0 | No distant metastases. | |
| S2 | LDH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
| Any pT/TX | See above descriptions | |
| Any N | See descriptions in this table, Stage III. | |
| M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
| S2 | LDH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
| Stage IIIC | Any pT/TX | See above descriptions. |
| cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
| cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
| cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
| pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
| pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
| M0 | No distant metastases. | |
| S3 | LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |
| Any pT/TX | See above descriptions. | |
| Any N | See descriptions in this table, Stage III. | |
| M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
| S3 | LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |
| Any pT/TX | See above descriptions. | |
| Any N | See descriptions in this table, Stage III. | |
| M1b | Nonpulmonary visceral metastases. | |
| SX | Marker studies not available or not performed. | |
| S0 | Marker study levels within normal limits. | |
| S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
| S2 | DH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
| S3 | LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. |
References
References
- ↑ Benson CB (August 1988). “The role of ultrasound in diagnosis and staging of testicular cancer”. Semin Urol. 6 (3): 189–202. PMID 3072643.
- ↑ Marth D, Scheidegger J, Studer UE (1990). “Ultrasonography of testicular tumors”. Urol. Int. 45 (4): 237–40. doi:10.1159/000281715. PMID 2163557.
- ↑ Boccellino M, Vanacore D, Zappavigna S, Cavaliere C, Rossetti S, D’Aniello C, Chieffi P, Amler E, Buonerba C, Di Lorenzo G, Di Franco R, Izzo A, Piscitelli R, Iovane G, Muto P, Botti G, Perdonà S, Caraglia M, Facchini G (November 2017). “Testicular cancer from diagnosis to epigenetic factors”. Oncotarget. 8 (61): 104654–104663. doi:10.18632/oncotarget.20992. PMC 5732834. PMID 29262668.
- ↑ “Testicular Cancer Treatment (PDQ®)—Health Professional Version – National Cancer Institute”.
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