Defining the Stages
Testicular cancer is staged and treated based how far the cancer has spread. It takes into account the primary (original) tumor size, number of tumors and whether it has metastasized, or spread to the lymph nodes or distant parts of the body. Once these categories have been assigned, they are combined to determine an overall stage of disease: I, II, III or IV. In most cases, the lower the number, the better the prognosis.
The following stages are used to describe testicular cancer: The American Joint Committee on Cancer (AJCC) uses the TNM classification to define the stages of testicular cancer:
- T is for Tumor. The number after the T indicates the size of the tumor and how far it has invaded. The larger the number, the bigger and/or more invasive the cancer.
- T0 means there is no evidence of primary tumor.
- Tis means intratubular germ cell neoplasia, more commonly called carcinoma.
- T1 means the tumor is confined to the testes and the epididymis, it has not invaded either the blood or lymphatic systems; it may invade into the tunica albuginea (the dense fibrous membrane enclosing the penis), but not invaded the tunica vaginalis (membrane covering the front and sides of the testis and epididymis).
- T2 means the tumor is limited to the testis and epididymis with invasion into the blood lymph system, or the tumor extends through the tunica albuginea and has involved the tunica vaginalis.
- T3 means the tumor has invaded the spermatic cord with or without invasion into the blood or lymph systems.
- T4 means the tumor has invaded the scrotum with or without invasion into the blood or lymph systems.
- N is for Nodes. The number after the N indicates whether the cancer has spread to the lymph nodes and to what extent.
- N0 means there is no cancer in the lymph nodes in the region of the cancer.
- N1 means there has been metastasis, with a lymph nodes mass of 2 cm or less; or multiple lymph node metastases with none of them greater than 2 cm in size.
- N2 means there has been metastasis to one or more lymph nodes and they are more than 2 cm in size, but less then 5 cm.
- N3 means there is at least one lymph node containing a metastasis of at least 5 cm in size.
- M is for Metastasis. The number after the M indicates whether the cancer has spread to distant areas of the body.
- Mx means that metastasis cannot be assessed.
- M0 means there is no distant metastasis.
- M1 means the cancer has metastasized to at least one site distant from the testicles.
- M1a Metastasis to a lymph node outside the region of the original tumor or to the lung.
- M1b Distant metastasis to any other location.
In staging testicular cancer, another factor may be included — serum tumor markers, noted by the letter S. (Sx means the tumor marker results are not available; S3 means the LDH was over 10 or the hCG was over 50,000 or the AFP was over 10,000.)
- Sx means the marker studies were not done or the results were not available.
- S0 means the marker study levels were within normal limits.
- S1 means the LDH was less than 1.5 and the hCG was less then 5,000.
- S2 means the LDS was between 1.5 and 10 OR the hCG was between 5,000 and 50,000 OR the AFP was between 1,000 and 10,000.
- S3 means the LDH was over 10 OR the hCG was over 50,000 OR the AFP was over 10,000.