Seminoma staging stage grouping

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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]

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

The staging for testicular seminoma is performed according to the TNM system with stage 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

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.

Stage	TNM and S	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.

Stage I

Stage I testicular cancer can be one of the following.

Stage	TNM and S	Explanation
Stage IA	T1	Tumor is only in the testicle and epididymis. It hasn’t grown into lymph or blood vessels. The tumor may have grown into the tunica albuginea.
	N0	There is no regional lymph node metastasis.
	M0	There is no distant metastasis.
	S0	Serum tumor marker levels are normal.
Stage IB	T2, T3, T4	Tumor is in the testicle and epididymis. It has grown into lymph or blood vessels or the tumor is in the tunica vaginalis.The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N0	There is no regional lymph node metastasis.
	M0	There is no distant metastasis.
	S0	Serum tumor marker levels are normal.
Stage IS	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N0	There is no regional lymph node metastasis.
	M0	There is no distant metastasis.
	S1, S2, S3	One or more serum tumor markers are higher than normal.

Stage II

Stage II testicular cancer can be one of the following.

Stage	TNM and S	Explanation
Stage IIA	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both [[tunica albuginea] and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N1	There is regional lymph node metastasis. There are cancer cells in 1–5 lymph nodes near the testicle. None of the lymph nodes are larger than 2 cm in diameter.
	M0	There is no distant metastasis.
	S0, S1	Serum tumor marker levels are normal or slightly high.
Stage IIB	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both [[tunica albuginea] and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N2	There is regional lymph node metastasis. Cancer cells are in one lymph node that is 2–5 cm in diameter or in more than 5 lymph nodes but none of the lymph nodes are larger than 5 cm in diameter. The cancer may have spread outside of the lymph nodes to surrounding tissues (extranodal tumor extension).
	M0	There is no distant metastasis.
	S0, S1	Serum tumor marker levels are normal or slightly high.
Stage IIC	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both [[tunica albuginea] and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N3	There is regional lymph node metastasis. There are cancer cells in at least one lymph node. The lymph nodes with cancer are larger than 5 cm in diameter.
	M0	There is no distant metastasis.
	S0, S1	Serum tumor marker levels are normal or slightly high.

Stage III

Stage III testicular cancer can be one of the following.

Stage	TNM and S	Explanation
Stage IIIA	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	any N	There may or may not be regional lymph node metastasis. The tumor may have extranodal tumor extension.
	M1a	There is distant metastasis, i.e. the cancer has spread to lymph nodes farther from the testicle or to the lungs.
	S0, S1	Serum tumor marker levels are normal or slightly high.

Stage	TNM and S	Explanation
Stage IIIB	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N1, N2, or N3	There is regional lymph node metastasis. The tumor may have extranodal tumor extension.
	M0	There is no distant metastasis.
	S2	Serum tumor marker levels are high.
Stage IIIB	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	any N	There may or may not be regional lymph node metastasis. The tumor may have extranodal tumor extension.
	M1a	There is distant metastasis, i.e. the cancer has spread to lymph nodes farther from the testicle or to the lungs.
	S2	Serum tumor marker levels are high.

Stage	TNM and S	Explanation
Stage IIIC	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	N1, N2, or N3	There is regional lymph node metastasis. The tumor may have extranodal tumor extension.
	M0	There is no distant metastasis.
	S3	Serum tumor marker levels are very high.
Stage IIIC	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	any N	There may or may not be regional lymph node metastasis. The tumor may have extranodal tumor extension.
	M1a	There is distant metastasis, i.e. the cancer has spread to lymph nodes farther from the testicle or to the lungs.
	S3	Serum tumor marker levels are very high.
Stage IIIC	any T	Tumor is in the testicle and epididymis. It may have grown into lymph or blood vessels. Or the tumor has grown into the tunica albuginea or both tunica albuginea and tunica vaginalis. The tumor may have spread to the spermatic cord or scrotum, and may have grown into lymph or blood vessels.
	any N	There may or may not be regional lymph node metastasis. The tumor may have extranodal tumor extension.
	M1b	There is distant metastasis to an organ other than the lung, such as the liver or a bone.
	any S	Serum tumour marker levels are normal, high, or very high.