Testicular Cancer Staging

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.

 

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