Seminoma staging: Difference between revisions

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Latest revision as of 04:16, 29 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

According to the TNM classification and stage groupings, there are 3 stages of seminoma based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.

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).^[1]


Stage	TNM/S	Description

Stage 0	pTis^b	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.
	pT1a^b	Tumor <3 cm in size
	pT1b^b	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.
	pT1a^a	Tumor <3 cm in size
	pT1b^b	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.
	pT1a^b	Tumor 3 cm in size.
	pT1b^b	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 × N^c and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
	S2	LDH 1.5–10 × N^c or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
	S3	LDH > 10 × N^c 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 × N^b 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 × N^b 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 × N^b 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 × N^b 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 × N^b 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 × N^b 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 × N^b 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 × N^b 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 × N^b and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
	S2	DH 1.5–10 × N^b or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
	S3	LDH > 10 × N^b or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.

References

↑ "Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute".

Template:WH Template:WS

[urlTesticular_Cancer_Treatment_(PDQ®)—Health_Professional_Version_-_National_Cancer_Institute-1] "Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute".

[1]

@@ Line 7: / Line 7: @@
 ==Staging==
-The staging for [[Testicle|testicular]] seminoma is performed according to the '''[[Seminoma staging TNM|TNM system]]''' with '''[[Seminoma staging stage grouping|staging groupings]]'''. It can be remembered in its abbreviated form as:<ref name="stagingofgermcelltumoiukjrsg">Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 29, 2016</ref><ref name="testiculartumorstGING1">Testicular cancer staging. Dr Marcin Czarniecki and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-cancer-staging. Accessed on February 26, 2016</ref>
-*'''Stage I''': confined to testis, epididymis, spermatic cord, scrotum
-*'''Stage II''': [[Lymph node|lymph nodes]] involved but no distant [[Metastasis|metastases]], and [[serum]] [[Tumor marker|tumor markers]] are not very high
-*'''Stage III''': distant [[Metastasis|metastases]] or moderately high serum [[Tumor marker|tumor markers]]
 *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).<ref name="urlTesticular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/testicular/hp/testicular-treatment-pdq#_721 |title=Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
-{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
-|valign=top|
+| valign="top" |
 |+
 ! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| Stage}}
@@ Line 21: / Line 17: @@
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Description}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=5|Stage 0
+| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Stage 0
 | style="padding: 5px 5px; background: #F5F5F5;" |pTis<sup>b</sup>
 | style="padding: 5px 5px; background: #F5F5F5;" |Germ cell neoplasia in situ
@@ Line 37: / Line 33: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |SO Marker study levels within normal limits
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=10|Stage I
+| rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage I
 | style="padding: 5px 5px; background: #F5F5F5;" |pT1
 | style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
@@ Line 68: / Line 64: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=7|Stage IA
+| rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" |Stage IA
 | style="padding: 5px 5px; background: #F5F5F5;" |pT1
 | style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
@@ Line 90: / Line 86: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=15|Stage IB
+| rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage IB
 | style="padding: 5px 5px; background: #F5F5F5;" |pT2
 | style="padding: 5px 5px; background: #F5F5F5;" |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.
@@ Line 136: / Line 132: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=15|Stage IS
+| rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage IS
 | style="padding: 5px 5px; background: #F5F5F5;" |pTX
 | style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed.
@@ Line 182: / Line 178: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>c</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=9|Stage II
+| rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" |Stage II
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed.
@@ Line 210: / Line 206: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=5|Stage IIA
+| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIA
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed.
@@ Line 226: / Line 222: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=10|Stage IIB
+| rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIB
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |See above description.
@@ Line 257: / Line 253: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=10|Stage IIC
+| rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIC
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |See above description.
@@ Line 288: / Line 284: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=15|Stage III
+| rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage III
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |See above description.
@@ Line 334: / Line 330: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=8|Stage IIIA
+| rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIA
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |See above description.
@@ Line 359: / Line 355: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=13|Stage IIIB
+| rowspan="13" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIB
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions
@@ Line 399: / Line 395: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |LDH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" rowspan=21|Stage IIIC
+| rowspan="21" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIC
 | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
 | style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions.

Seminoma staging: Difference between revisions

Latest revision as of 04:16, 29 April 2019

Overview

Staging

References

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