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Testicular cancer

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Staging testicular cancer

Staging is a way of describing or classifying a cancer based on the extent, or amount, of cancer in the body. The most common staging system for testicular cancer is the TNM system.

  • T describes the size of the primary tumour and if it has grown into tissues around the testicle.
  • N describes the number and location of any lymph nodes around the testicle that have cancer cells in them.
  • M describes whether or not the cancer has spread, or metastasized, to other parts of the body.

The American Joint Committee on Cancer (AJCC) includes serum tumour marker levels in the stages for germ cell tumours. Doctors use S to describe the levels of serum tumour markers in the blood after surgery to remove the testicle (called orchiectomy). The serum tumour markers measured are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH).

SSerum tumour marker levels

SX

Tumour marker levels are not available or have not been measured.

S0

Tumour marker levels are normal.

S1

All tumour marker levels are above normal.

  • AFP is less than 1,000 ng/mL.
  • HCG is less than 5,000 mIU/mL.
  • LDH is less than 1.5 times the upper limit of the normal range.

S2

At least one tumour marker level is high.

  • AFP is between 1,000 and 10,000 ng/mL.
  • HCG is between 5,000 and 50,000 mIU/mL.
  • LDH is 1.5–10 times the upper limit of the normal range.

S3

At least one tumour marker level is very high.

  • AFP is higher than 10,000 ng/mL.
  • HCG is higher than 50,000 mIU/mL.
  • LDH is more than 10 times the upper limit of the normal range.

Stage grouping for testicular cancer

Overall stage, or stage grouping, is based on the TNM system and serum tumour marker levels (S). Each stage is given a number from 0 to 3, usually as a Roman numeral (0, I, II or III). Generally, the higher the number, the more the cancer has progressed. Your healthcare team uses the stage grouping to plan treatment and estimate prognosis.

When describing the stage, doctors may use the terms localized, regional and distant. Localized means that the cancer is only in the area where it started and has not spread to other parts of the body. Regional means close to or around the testicle. Distant means in a part of the body farther from the testicle.

Stage 0

The following describes all stage 0 testicular cancers.

StageTNM and SExplanation

stage 0

Tis

Intratubular germ cell neoplasia, unclassified (IGCNU), is present.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S0

Serum tumour marker levels are normal.

Stage I

Stage I testicular cancer can be one of the following.

StageTNM and SExplanation

stage IA

T1

The tumour is only in the testicle and epididymis. It hasn’t grown into lymph or blood vessels. The tumour may have grown into the inner layer of the testicle (called the tunica albuginea).

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S0

Serum tumour marker levels are normal.

stage IB

T2, T3 or T4

The tumour is in the testicle and epididymis. It has grown into lymph or blood vessels. Or the tumour is in the outer layer of the testicle (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S0

Serum tumour marker levels are normal.

stage IS

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S1, S2 or S3

One or more serum tumour markers are higher than normal.

Stage II

Stage II testicular cancer can be one of the following.

StageTNM and SExplanation

stage IIA

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

N1

There is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle). There are cancer cells in 1–5 lymph nodes near the testicle. None of the lymph nodes are larger than 2 cm in diameter.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S0 or S1

Serum tumour marker levels are normal or slightly high.

stage IIB

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

N2

There is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle). Cancer cells are in one lymph node that is 2–5 cm in diameter. Or cancer cells are in more than 5 lymph nodes but none of the lymph nodes are larger than 5 cm in diameter.

The cancer may have spread outside of the lymph nodes to surrounding tissues (called extranodal tumour extension).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S0 or S1

Serum tumour marker levels are normal or slightly high.

stage IIC

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

N3

There is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle). There are cancer cells in at least one lymph node. The lymph nodes with cancer are larger than 5 cm in diameter.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S0 or S1

Serum tumour marker levels are normal or slightly high.

Stage III

Stage III testicular cancer can be one of the following.

StageTNM and SExplanation

stage IIIA

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

any N

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

Or there is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle).

The tumour may have spread outside of the lymph nodes to surrounding tissues (extranodal tumour extension).

M1a

There is distant metastasis (cancer has spread to lymph nodes farther from the testicle or to the lungs).

S0 or S1

Serum tumour marker levels are normal or slightly high.

StageTNM and SExplanation

stage IIIB

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into to lymph or blood vessels.

N1, N2 or N3

There is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle).

The tumour may have spread outside of the lymph nodes to surrounding tissues (extranodal tumour extension).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S2

Serum tumour marker levels are high.

stage IIIB

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has spread to the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

any N

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

Or there is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle).

The tumour may have spread outside of the lymph nodes to surrounding tissues (extranodal tumour extension).

M1a

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Or there is distant metastasis (cancer has spread to lymph nodes farther from the testicle or to the lungs).

Or there is distant metastasis to an organ other than the lung, such as the liver or a bone.

S2

Serum tumour marker levels are high.

StageTNM and SExplanation

stage IIIC

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

N1, N2 or N3

There is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle).

The tumour may have spread outside of the lymph nodes to surrounding tissues (extranodal tumour extension).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

S3

Serum tumour marker levels are very high.

stage IIIC

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has grown into the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into to lymph or blood vessels.

any N

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

Or there is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle).

The tumour may have spread outside of the lymph nodes to surrounding tissues (extranodal tumour extension).

M1a

There is distant metastasis (cancer has spread to lymph nodes farther from the testicle or to the lungs).

S3

Serum tumour marker levels are very high.

stage IIIC

any T

The tumour is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumour has spread to the inner layer of the testicle (tunica albuginea) or both the inner layer and the outer layer (tunica vaginalis).

The tumour may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.

any N

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the testicle).

Or there is regional lymph node metastasis (cancer cells are in lymph nodes near the testicle).

The tumour may have spread outside of the lymph nodes to surrounding tissues (extranodal tumour extension).

M1b

There is distant metastasis to an organ other than the lung, such as the liver or a bone.

any S

Serum tumour marker levels are normal, above normal or very high.

International Germ Cell Cancer Consensus Group classification system

The International Germ Cell Cancer Consensus Group (IGCCCG) developed a classification system based on prognostic factors. This system helps doctors make decisions about treatment for advanced germ cell tumours, such as stage III and recurrent testicular cancer. IGCCCG divides testicular germ cell tumours into prognosis groups. Doctors often use the IGCCCG system along with staging to predict prognosis. Find out more about IGCCCG classification system.

Restaging

Sometimes the healthcare team gives the cancer a stage after treatment. They will use imaging tests and serum tumour marker tests to find out the stage. This is called restaging. Restaging helps doctors determine if any cancer remains after treatment (called residual disease) and if you need more treatment.

Recurrent testicular cancer

Recurrent testicular cancer means that the cancer has come back after it has been treated. If the cancer comes back in the same area that it first started or in the other testicle, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called metastatic testicular cancer.

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