Staging is a process that physicians use to classify your cancer and determine the most effective approach for treating it.
Your physician will assign your cancer a stage from the earliest stage, Stage 0 (Carcinoma in situ) to Stage 3. Some stages are divided further into A and B to include more factors about your cancer. (Testicular cancer does not have a stage 4)
Staging testicular cancer involves an assessment of four specific characteristics of your cancer, including:
- Your tumor (T). How many tumors are found and how large are they? Have they invaded or grown into other parts of the testicle or nearby tissues and structures? With testicular cancer, you physician may initially assign your tumor to a clinical T (cT) category based on clinical exams and scans. After the tumor or tumors are removed and the tissue analyzed by pathologist, it will be classified to a pathologic T (pT) category.
- Lymph nodes (N). Are cancer cells found in any of the nearby lymph nodes and if so, how many of them?
- Metastasis (M). Has the cancer spread, or metastasized, or other areas of the body, such as distant lymph nodes, the lungs, bones or liver?
- Serum tumor markers (S). Does your blood test show that the level of these markers — Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (β-hCG) and Lactate dehydrogenase (LDH) — is higher than normal?
Stage 0 testicular cancer
If your cancer is classified as Stage 0 or carcinoma in situ, it means that cancer cells were only found in the seminiferous tubules, small tubes in the testicle where sperm is made, and not in other areas of the testicle. This also means that cancer was not found in any lymph nodes or distant areas of the body and the tumor markers in your blood are all in normal range. Patients with carcinoma in situ (CIS) do not require additional treatment, but they should undergo routine surveillance since CIS is a risk factor for developing testicular cancer.
Stage 1 testicular cancer
Stage 1 describes testicular cancers where the tumor has spread beyond the seminiferous tubules in the testicle. Stage 1 is further classified as 1, 1A, 1B and 1S according to whether or not the tumor has spread outside the testicle or into nearby structures. Stage 1 cancers have not spread to any lymph nodes or distant areas, but one of your serum tumor markers may be abnormal (1S). Treatment for stage 1 testicular cancer will depend on several factors, including whether the cancer is seminoma or nonseminomatous. Options would include surveillance, radiation or chemotherapy, but surveillance is preferred.
Stage 2 testicular cancer
Stage 2 also describes testicular cancers where the tumor has spread beyond the seminiferous tubules in the testicle, and they may (or may not) have grown outside the testicle. But Stage 2 means that cancer cells are found in at least one nearby lymph node. Stage 2 cancers are classified as Stage 2, 2A, 2B or 2C, depending largely on how many lymph nodes are found to have cancer, and how large the nodes are. Generally, stage 2 seminoma tumors are treated with radiation or chemotherapy. Stage 2 nonseminomatous tumors may require chemotherapy or an operation called retroperitoneal dissection to remove lymph nodes deep in the abdomen.
Stage 3 testicular cancer
Testicular cancers are assigned Stage 3 if cancer is found in a distant area of the body, such as your lungs, bones or liver, or a distant lymph node. This means the cancer has metastasized. The new area of cancer is still testicular cancer. Stage 3 cancers are further classified as Stage 3, 3A, 3B or 3C, but this classification depends on a number of factors, including the number and size of affected nearby lymph nodes, whether you have serum tumor markers that are elevated or very high. All stage 3 testicular cancers will require chemotherapy.
Recurrent testicular cancer
Because the overwhelming majority of testicular cancer patients are cured, recurrent disease is rare. If testicular does recur however, it’s not usually found in the primary site or scrotum, but in other areas such as lymph nodes the brain or lungs.
Treatment for recurrent disease may involve:
- Surgery to remove any new areas of cancer
- Chemotherapy with a different combination of drugs
- High-dose chemotherapy with stem cell transplant