Seminoma staging

Seminoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Seminoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging TNM Stage Grouping
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy Treatment - Stage I Treatment - Stage II Treatment - Stage III Treatment - Recurrent
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Seminoma staging On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Seminoma staging All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Seminoma staging
CDC on Seminoma staging
Seminoma staging in the news
Blogs on Seminoma staging
Directions to Hospitals Treating Seminoma
Risk calculators and risk factors for Seminoma staging

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 (abdominal retroperitoneal 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 (orchiectomy not performed)
T0	No evidence of primary tumor
Tis	Intratubular germ cell neoplasia (carcinoma in situ)
T1	Tumor limited to testis and epididymis May invade tunica albuginea May NOT invade tunica vaginalis No vascular or lymphatic invasion
T2	Tumor limited to testis and epididymis Involvement of tunica vaginalis Vascular or lymphatic invasion
T3	Invasion of the spermatic cord
T4	Invasion of the scrotum
Regional Lymph Nodes (N)
NX	Regional lymph nodes cannot be assessed
N0	No evidence of nodal involvement
N1	One or more lymph nodes involved, but all <2 cm in greatest dimension
N2	One or more lymph nodes involved 2-5 cm in greatest dimension
N3	One or more lymph nodes involved >5 cm in greatest dimension
Distant Metastasis (M)
MX	Presence of metastases cannot be assessed
M0	No evidence of metastases
M1	Distant metastases present M1a: non-regional lymph node OR pulmonary metastases M1b: distant metastases not fulfilling M1a

Stage Grouping for Testicular Seminoma

Stage grouping, is based on the TNM system and serum tumor 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.

Stage 0

The following describes all stage 0 testicular cancers.

UICC Stage	TNM	Explanation
Stage 0	Tis	Intratubular germ cell neoplasia, unclassified (IGCNU), is present.
	N0	There is no regional lymph node metastasis.
	M0	There is no distant metastasis.
	S0	Serum tumor marker levels are normal.