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 (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 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