Testicular cancer staging

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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]

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Overview

The diagnostic study of choice for testicular cancer is scrotal ultrasound.

Diagnostic Study of Choice

Staging

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

  1. ↑ Benson CB (August 1988). "The role of ultrasound in diagnosis and staging of testicular cancer". Semin Urol. 6 (3): 189–202. PMID 3072643.
  2. ↑ Marth D, Scheidegger J, Studer UE (1990). "Ultrasonography of testicular tumors". Urol. Int. 45 (4): 237–40. doi:10.1159/000281715. PMID 2163557.
  3. ↑ 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.
  4. ↑ "Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute".


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