Seminoma staging

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

Staging

The staging for testicular seminoma is performed according to the TNM system with staging groupings. It can be remembered in its abbreviated form as:

• Stage I: confined to testis, epididymis, spermatic cord, scrotum
• Stage II: lymph nodes involved but no distant metastases, and serum tumor markers are not very high
• Stage III: distant metastases or moderately high serum tumor markers

The American Joint Committee on Cancer (AJCC) includes serum tumor marker levels in the stages for germ cell tumors, including seminoma. S describes the levels of serum tumour markers in the blood after orchiectomy. The serum tumor markers measured are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH).

S	Serum tumor marker levels
SX	Tumor marker levels are not available or have not been measured.
S0	Tumor marker levels are normal.
S1	All tumor 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 tumor 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 tumor 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.

TNM Classification for Seminoma

TNM stands for tumor, nodes, and metastasis. TNM staging describes:

• size and extent of the primary tumor
• number and location of any regional lymph nodes infiltrated by tumor cells
• whether the cancer metastasized to distant part of the body

TNM Classification	Definition
Primary Tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor involves the ipsilateral parietal pleura, with or without focal involvement of the visceral pleura. T1a – Tumor involves the ipsilateral parietal pleura and may also be in the pleura lining the diaphragm or the mediastinum. There is no tumor in the visceral pleura. T1b – Tumor involves both the ipsilateral parietal pleura and the visceral pleura.
T2	Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following: tumor in the visceral pleura, including the fissures of the lung invasion of the diaphragm invasion of the lung parenchyma
T3	Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following: invasion of the endothoracic fascia invasion into mediastinal fat solitar tumor invading soft tissues of the chest wall non-transmural involvement of the pericardium T3 describes mesothelioma that is locally advanced, but potentially resectable
T4	Tumor involves any of the ipsilateral pleural surfaces, with at least one of the following: diffuse or multifocal invasion of soft tissues of the chest wall rib involvement invasion through the diaphragm and into the peritoneum invasion of any organ in the mediastinum extension to the contralateral pleura invasion into the spine extension to the internal surface of the pericardium pericardial effusion with positive cytology invasion of myocardium invasion of nerves of the brachial plexus T4 describes mesothelioma that is locally advanced, but unresectable
Regional Lymph Nodes (N)
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in either or both the ipsilateral bronchopulmonary lymph nodes and the hilar lymph nodes. Bronchopulmonary lymph nodes are within the lungs. Hilar lymph nodes are near where the bronchus enters the lung.
N2	Metastasis in ipsilateral subcarinal lymph nodes and in either the internal mammary lymph nodes or mediastinal lymph nodes on the same side. OR Metastasis in subcarinal lymph nodes or in either the internal mammary lymph nodes or mediastinal lymph nodes on the same side of the chest as the cancer. Subcarinal lymph nodes are below the trachea. Internal mammary lymph nodes are around the sternum. Mediastinal lymph nodes are in the mediastinum.
N3	Metastasis in the contralateral mediastinal lymph nodes, internal mammary lymph nodes, or hilar lymph nodes and in either the supraclavicular lymph node or scalene lymph nodes on the ipsilateral or contralateral side. OR Metastasis in the contralateral mediastinal, internal mammary, or hilar lymph nodes or in either the supraclavicular or scalene lymph nodes on the ipsilateral or contralateral side. Supraclavicular lymph nodes are located above the clavicle. Scalene lymph nodes are located at the base of the neck.
Distant Metastasis (M)
M0	No distant metastasis
M1	Distant metastasis