The AJCC -UICC joint system is generally agreed upon and is unique in that it incorporates tumor marker data as part of the staging [Table 1]. It is hoped that greater use of this system will standardize reporting for this condition
Table 1. AJCC Staging System for Testis Carcinoma
| Primary Tumor T Stage (pT) | |
| pTO | No evidence of tumor in testis (scar may be present) |
| pTis | Intratubular germ cell neoplasia (CIS) |
| pT1 | Tumor limited to the testis/epdidymis without vascular or lymphatic invasion; tumor may invade the tunica albuginea but not the tunica vaginalis |
| pT2 | Tumor limited to the testis/epididymis with vascular or lymphatic invasion or tumor extending to and involving the tunica vaginalis |
| pT3 | Tumor invading the spermatic core ± vascular or lymphatic invasion |
| pT4 | Tumor invading the scrotum ± vascular or lymphatic invasion |
| Regional Nodes (N) | |
| pNX | Regional lymph nodes cannot be assessed |
| pNO | No regional lymph node metastasis |
| pN1 | Metastasis with a lymph node mass, 2 cm or less in greatest dimension and less than or equal to 5 nodes positive, none more than 2 cm in greatest dimension |
| pN2 | Metastasis with a lymph node mass, more than 2 cm but not more than 5 cm in greatest dimension; or more than 5 nodes positive, none more than 5 cm; or evidence of extra nodal extension of tumor |
| pN3 | Metastasis with a lymph node mass more than 5 cm in greatest dimension |
| Distant Metastasis (M) | |
| MX | Distant metastasis cannot be assessed |
| MO | No distant metastasis |
| M1 | Distant metastasis |
| Mla | Nonregional nodal or pulmonary metastasis |
| Mlb | Distant metastasis other than to nonregional lymph node and lungs |
| Serum Tumor Markers (S) | |
| SX | Marker studies not available |
| SO | Markers within normal limits |
| S l | LDH < 1.5 x Normal AND hCG < 5000 mIu/mL AND AFP < 1000 ng/mL |
| S2 | LDH 1.5-10 x N OR hCG 5,000 to 50,000 mIu/mL OR AFP 1000-10,000 ng/mL |
| S3 | LDH > 10 x N OR hCG > 50,000 mIu/mL OR AFP > 10,000 ng/mL |
| Definitions of Clinical Stages for Testis Cancer | |
| I or A Tumor | Tumor confined to the testicle or cord structure |
| IIA or B 1 | Microscopic regional lymph node involvement in < 6 nodes |
| IIB or B2 | Microscopic involvement in > 6 regional lymph nodes or gross nodal involvement < 6 cm |
| IIC or B2 | Gross nodal involvement > 6 cm in one lymph node or as an aggregate of lymph nodes |
| III or C | Disease above the diaphragm or involving abdominal organs |
| (Regional Nodes) Clinical | |
| NX | Regional lymph nodes cannot be assessed |
| NO | No regional lymph node metastasis |
| N1 | Metastasis with a lymph node mass 2 cm or less in greatest dimension; or multiple lymph nodes, none more than 2 cm in greatest dimension |
| N2 | Metastasis with a lymph node mass, more than 2 cm but not more than 5 cm in greatest dimension; or multiple lymph nodes any one mass greater than 2 cm but not more than 5 cm in greatest dimension |
| N3 | Metastasis with a lymph node mass more than 5 cm in greatest dimension |
References
- Baniel J, Foster RS, Rowland RG, Bihrle R, Donahue JP: Testis cancer: Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol 153:976-980, 1995.
- Donohue JP, Thornhill JA, Foster RS, Bihrle R, Rowland RG, Einhorn LH: The role of retroperitoneal lymphadenectomy in clinical stage B testis cancer: The Indiana University experience (1965 to 1989). J Urol 153:85-89, 1995.
- Einhorn LH: Salvage therapy for germ cell tumors. Semin Oncol 21:47-51, 1994.
- Einhorn LH, Donohue JP: Advanced testicular cancer: Update for urologists. J Urol 160:1964-1969. 1998.
- Moller H, Skakkeback NE: Testicular cancer and cryptorchidism in relation to prenatal factors: Case control studies in Denmark. Cancer Causes Control 8:904-12, 1997.
- Nichols C, Loehrer P Sr: The story of second cancers in patients cured of testicular cancer: Tarnishing success of burnishing irrelevance. J Natl Cancer Inst 89:1304-1305, 1997.
- Wegner HEH, Hubotter A, Andresen R, Miller K: Testicular microlithiasis and concomitant testicular intraepithelial neoplasia. Int Urol Nephrol 30:313-315, 1998.