close

Testicular Cancer Staging

Testicular cancer staging - You will learn about how doctors describe a cancer's growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing if and where the cancer has spread. Doctors use diagnostic tests, including CT scans and blood tests, to determine the stage of the cancer, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what type of treatment is best and helps predict prognosis of patients, which is the chance of recovery. There is a Description of the different stages for this type of cancer.
Testicular Cancer Staging

System TNM staging

One tool that doctors use to describe the stage is the system of TNM. For testicular cancer, S is added to the system TNM. Doctors use the results of diagnostic tests and scans to answer this question:

  • Tumor (T): How large is the primary tumor? Where is it located?
  • Node (N): the Tumor has spread to the lymph nodes in the back of the abdomen (retroperitoneum)?
  • Metastasis (M): the Cancer has spread to other parts of the body? If so, where and how much?
  • Tumor markers in serum (S): is the serum tumor markers AFP, beta-hCG, and LDH (See Diagnosis) elevated? If yes, how high Are they?


The results are combined to determine the stage of cancer for each person. There are 3 stages of testicular cancer: stage I, II, and III (1, 2, and 3). The stage provides a common way to describe how advanced the cancer so doctors can work together to plan the best treatment. Phase I is the most advanced and stage III is the most advanced. Patients with stage less advanced is more likely to be cured and often need less aggressive treatment than patients with more advanced cancer.

There are also 2 types of staging in cancer:

  • Staging clinical. The clinical stage is based on physical examination or x-ray, CT scan and another test (See Diagnosis). For example, clinical Stage II testicular cancer means that the retroperitoneal lymph nodes are enlarged when viewed with a CT scan or MRI.
  • The staging of the pathological. Pathological stage is based on evaluating tissue under a microscope after it has been removed during the operation. For example, pathological stage II testicular cancer means that the cancer has been found when tissue removed from the lymph nodes retroperitoneal examined under a microscope. Pathological staging is more accurate than staging clinical, but it is not always necessary.


Here are more details on each part of the system TNM for testicular cancer:

Tumor (T)

Using a system of TNM, the "T" plus a letter or number (0-4) is used to describe the size and location of the tumor. Some stages are also divided into small groups that can help describe the tumor in more detail. For testicular cancer, the stage of T can only be determined when tissue removed during surgery is examined under a microscope. This means that the phase T is determined only after the testes are removed, and stage T pathological stage and never stage clinical. "P" before the stage of T shows that it is a stage of pathological. Information a certain stage of the tumor at the bottom of this.

pTX: primary tumor cannot be assessed. If a man does not have the testicle(s) surgically removed, the term "TX" is used.

pT0: no evidence of primary tumor in the testicles.

PALM: at this stage, there neoplasia intratubular germ cells, also called carcinoma in situ (CIS). This is a precancerous condition in which there are germ cells that appear cancerous but are not yet behaving cancer cells how to do. CIS becomes cancer when the cells spread to the testicle(s) where they are not usually included.

pT1: the primary tumor is only in the testicle with or without involvement of the rete epididymis or the testes. It has not grown into blood vessels or lymph vessels in the testicles. The Tumor has grown into the inner lining of the membrane around the testicle, called the tunica albuginea. Has not spread to the layer of the outer membrane surrounding the testicle, called the tunica vaginalis.

pT2: the tumor is in the testicle with or without involvement of the rete epididymis or the testes. It has grown into blood vessels or lymphatic vessels, and/or has grown through the tunica albuginea and into the tunica vaginalis.

pT3: the tumor has grown into a cord spermatic.

pT4: the tumor has grown into the scrotum.

Node (N)

The "N" in the system TNM stands for lymph nodes, a small organ, shaped nuts that help fight infections. Lymph is the fluid that drains from various tissues and organs of the body and finally flows into the blood flow. This passes through special tubes called lymphatic vessels and is filtered along the way by the lymph nodes. Cancer cells often buildup and grow in the lymph nodes before they spread to other parts of the body. The first place that drains lymphatic fluid from the testicles to is the lymph nodes are retroperitoneal, located behind the stomach in front of the spine, an area called the retroperitoneum. This is called regional lymph nodes for testicular cancer. Lymph nodes in the pelvis, chest, or other parts of the body are called distant lymph nodes although the testes closer to the pelvic than to the retroperitoneum.

Men with testicular cancer, lymph nodes are usually not biopsied or removed. On the contrary, the "N" stage is most often estimated by using CT scan. Lymph node stage (N stage) that is based on CT scan, clinical stage, and N stage based on a biopsy or removal of lymph nodes is the stage of the pathological. When the stage has been determined pathologically, the letter "p" is added as the first letter of the stage (e.g. pN1). The letter "c" is the abbreviation of the clinical stages.

NX: regional lymph nodes cannot be assessed.

cN0: there is no spread to regional lymph nodes as seen on imaging tests.

pN0: there is a cancer not found in lymph nodes removed during RPLND (See treatment options).

cN1: imaging tests show signs that the cancer has spread to lymph nodes 1 or more in the retroperitoneum, and no lymph nodes larger than 2 centimeters (cm).

pN1: there is cancer in 1 to 5 lymph nodes and no greater than 2 cm.

cN2: imaging tests show at least 1 lymph node enlargement or mass of the lymph nodes in the retroperitoneum that is larger than 2 cm but not larger than 5 cm.

pN2: either or both of the following conditions:

There is cancer in more than 5 lymph nodes, but no greater than 5 cm.

There is cancer in at least 1 lymph node and of lymph node largest or lymph node mass greater than 2 cm but not larger than 5 cm.

cN3: imaging tests show at least 1 lymph node enlargement or lymph node mass in the retroperitoneum larger than 5 cm.

pN3: there is cancer in at least 1 lymph node enlargement or lymph node mass greater than 5 cm.

Metastasis (M)

The "M" in the TNM show whether the cancer has spread to other parts of the body, called distant metastases. When cancer spreads, it most often spreads to the lungs and lymph nodes of the chest, the pelvis and the base of the neck. A more advanced stage has spread to the liver and bones. Handle cancer rarely spreads to the brain unless the primary tumor is a choriocarcinoma.

MX: distant Metastasis can not be assessed.

M0: the Disease has not spread to distant lymph nodes or other organs.

M1: There is at least 1 distant metastasis.

M1a: There is cancer in the distant lymph nodes and/or lungs.

M1b: the Cancer has spread to organs other than the lungs. The lungs may or may not also engage. For example, cancer that has spread to the liver or the bones is stage M1b.

Tumor markers in serum (S)

Tumor marker serum also help to stage testicular cancer. A blood test for tumor markers will be done before and after surgical removal of the testicle(s). Tumor markers usually decrease after surgery. Generally, the levels need to be tested until they stop decreasing or begin to rise to determine the stage S is true. For patients receiving chemotherapy, the tumor marker levels on the first day of chemotherapy are used to determine the patient risk group (see below).

SX: the Levels of Tumor markers are not available, or the test has not been resolved.

S0: the Level of the Tumor marker is normal.

S1: at least 1 tumor marker level is above normal. This means that LDH is less than 1.5 times the upper limit of the normal range, beta-hCG is less than 5,000 mIu/mL, and AFP is less than 1,000 ng/mL.

S2: at least 1 tumor marker level is substantially above normal. This means that LDH is 1.5 to 10 times the upper limit of the normal range, beta-hCG is 5,000 to 50,000 mIu/mL, or AFP is 1,000 to 10,000 ng/mL, and none of the tumor markers is elevated high enough to qualify as S3 (see below).

S3: 1 or more tumor marker level is very high. This means that LDH is more than 10 times the upper limit of the normal range, beta-hCG is more than 50,000 mIu/mL or AFP more than 10,000 ng/mL.

The grouping stage of the cancer

Doctors assign the stage of the cancer by combining the T, N, and the classification of the M and the S level information.

Stage 0: Refers to carcinoma in situ, also called intratubular germ cell neoplasia (MLIA).

Stage I: cancer at the level of T any, and there is no evidence of spread to lymph nodes or other organs. Tumor marker serum level is not yet resolved or is not available (any T N0 M0, SX).

Stage IA: Cancer is in the testis and has grown into the tissues of the testes and epididymis, but it has not grown into lymphatic or blood vessels in the testis or spread to lymph nodes or remote site. Tumors in the testicles has grown into the membrane of the inner around the testis, called the tunica albuginea, but not the outer membrane, called the tunica vaginalis. Serum markers are normal (pT1, N0, M0, S0).

Stage IB: the testicular tumors has evolved into the tunica vaginalis, the blood or lymphatic vessels within the testicle, cord spermatic, or scrotum. The cancer has not spread to lymph nodes or remote site. Serum markers are normal (pT2, pT3, or pT4, and N0, M0, S0).

Stage IS: Cancer of any stage T and has not spread to lymph nodes or remote site. Serum markers remained higher than normal levels after testicular cancer has been removed (any T, N0, M0 and S1-3). Stage is non-seminoma testicular cancer is treated the same as stage III cancer.

Stage II: the Cancer has spread to the regional lymph nodes but not to lymph nodes in other parts of the body or distant organs. Serum markers are available (any T N1-3 M0, SX).

Stage IIA: Cancer has spread to the lymph nodes retroperitoneal, both clinical and pathological stage N1, but none is larger than 2 cm and if a lymph node dissection has been performed, no more than 5 lymph nodes contain cancer. In addition, tumor marker serum at a normal level or just a little high, and there are no signs of the cancer that has spread anywhere other than retroperitoneum (T, N1, M0, S0 or S1).

Stage IIB: Cancer has spread to the lymph nodes in the retroperitoneum, and lymph nodes the largest with cancer or lymph node mass is between 2 cm and 5 cm in size; or, if a lymph node dissection has been done, the cancer has spread to at least 1 lymph node (or lymph node mass) between 2 cm and 5 cm or more than 5 lymph nodes, no larger than 5 cm. Serum markers at normal levels or slightly high, and there is no evidence the cancer has spread anywhere other than retroperitoneum (any T, N2, M0, S0 or S1).

Stage IIC: Cancer has spread to at least 1 lymph node (or lymph node mass) that is larger than 5 cm. Serum markers at normal levels or slightly high and there is no evidence the cancer has spread anywhere other than retroperitoneum (T, N3, M0, S0 or S1).

Stage III: the Cancer has spread to distant lymph nodes or to any organ, and the levels of tumor markers in serum is not known (any T, N0-3, M1, SX).

Stage IIIA: the Cancer has spread to distant lymph nodes and/or lungs. Serum markers in the normal level or increased only slightly (any T, N0-3, M1a, S0 or S1).

Stage IIIB: Cancer has spread to any lymph nodes and/or lungs but not to other organs. At least 1 serum marker is substantially increased (any T, N1-3, M0, S2; or any T, N0-3, M1a, S2).

Stage IIIC: either or both of the following:

  • At least 1 serum marker is very high, and the cancer has spread to the lymph nodes at least 1 or organ (any T, N1-3, M0, S3; or any T, N0-3, M1a, S3).
  • The cancer has spread to organs other than the lungs (T any N any M1b, S any).