Primary tumor (T) - The extent of primary tumor is classified after radical orchiectomy.
• pTX: Primary tumor cannot be assessed (if no radical orchiectomy has been performed, TX is used.)
• pT0: No evidence of primary tumor (e.g., histologic scar in testis)
• pTis: Intratubular germ cell neoplasia (carcinoma in situ)
• pT1: Tumor limited to testis and epididymis without lymphatic/vascular invasion
• pT2: Tumor limited to testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
• pT3: Tumor invades the spermatic cord with or without vascular/lymphatic invasion
• pT4: Tumor invades the scrotum with or without vascular/lymphatic invasion
Regional lymph nodes (N)
• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in a single lymph node, 2 cm or less in greatest dimension
• N2: Metastasis in a single lymph node, more than 2 cm but not more than 5 cm in greatest dimension; or multiple lymph nodes, none more than 5 cm in greatest dimension
• N3: Metastasis in a lymph node more than 5 cm in greatest dimension
Distant metastasis (M)
• MX: Presence of distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis
• M1a: Non-regional nodal or pulmonary metastasis
• M1b: Distant metastasis other than to non-regional nodes and lungs
Serum tumor markers (S)
• SX: Tumor marker studies not available or not performed
• S0: Tumor marker levels within normal limits
• S1: LDH <> 10 X Normal or HCG (mIu/ml) > 50,000 or AFP (ug/ml) > 10,000
AJCC stage groupings
Stage 0 pTis, N0, M0, S0 Stage I
pT1-4, N0, M0, SX
Stage IA
pT1, N0, M0, S0
Stage IB
pT2, N0, M0, S0
pT3, N0, M0, S0
pT4, N0, M0, S0
Stage IS
Any pT/Tx, N0, M0, S1-3 Stage II
Any pT/Tx, N1-3, M0, SX
Stage IIA
Any pT/Tx, N1, M0, S0
Any pT/Tx, N1, M0, S1
Stage IIB
Any pT/Tx, N2, M0, S0
Any pT/Tx, N2, M0, S1
Stage IIC
Any pT/Tx, N3, M0, S0
Any pT/Tx, N3, M0, S1 Stage III
Any pT/Tx, Any N, M1, SX
Stage IIIA
Any pT/Tx, Any N, M1a, S0
Any pT/Tx, Any N, M1a, S1
Stage IIIB
Any pT/Tx, N1-3, M0, S2
Any pT/Tx, Any N, M1a, S2
Stage IIIC
Any pT/Tx, N1-3, M0, S3
Any pT/Tx, Any N, M1a, S3
Any pT/Tx, Any N, M1b, Any S
In addition to the clinical stage definitions, surgical stage may be designated based on the results of surgical removal and microscopic examination of tissue.
Stage I - Stage I testicular cancer is limited to the testis. Invasion of the scrotal wall by tumor or interruption of the scrotal wall by previous surgery does not change the stage but does increase the risk of spread to the inguinal lymph nodes, and this must be considered in treatment and follow-up. Invasion of the epididymis tunica albuginea and/or the spermatic cord also does not change the stage but does increase the risk of retroperitoneal nodal involvement and the risk of recurrence. This stage corresponds to AJCC stages I and II.
Stage II - Stage II testicular cancer involves the testis and the retroperitoneal or para-aortic lymph nodes usually in the region of the kidney. Retroperitoneal involvement should be further characterized by the number of nodes involved and the size of involved nodes. The risk of recurrence is increased if more than 5 nodes are involved, if the size of 1 or more involved nodes is larger than 2 centimeters, or if there is extranodal fat involvement. Bulky stage II disease describes patients with extensive retroperitoneal nodes (>5 centimeters) who require primary chemotherapy and who have a less favorable prognosis. This stage corresponds to AJCC stages III and IV (no distant metastasis).
Stage III - Stage III implies spread beyond the retroperitoneal nodes based on physical examination, x-rays, and/or blood tests. Stage III is subdivided into nonbulky stage III versus bulky stage III. In nonbulky stage III, metastases are limited to lymph nodes and lung with no mass larger than 2 centimeters in diameter. Bulky stage III includes extensive retroperitoneal nodal involvement, plus lung nodules or spread to other organs such as liver or brain. This stage corresponds to AJCC stage IV (distant metastasis).
