Staging
Staging testicular cancer is where the disease is assessed so that treatment decisions can be made. The cancer is given a metric so that it can be compared to other cases and treated in the best possible way.
How Testicular Cancer Staging Works
If you have been diagnosed with testicular cancer, your medical team will want to understand it in depth. The process of fully assessing the disease is called staging testicular cancer.
The factors that are taken into account are:
- Tumour size and location
- Any involvement with the lymph nodes
- Whether the cancer is localised or non-localised. Localised testicular cancer is where the cancer is only in one or both testicles. Non-localised testicular cancer is also known as ‘advanced’ or ‘metastatic’ cancer and is where the cancer has moved from the testicles into other organs of the body.
Understanding these factors will help you to get the best treatment.
The size and location of tumours, the presence of cancer in any lymph nodes and whether the cancer is localised or non localised are the three factors used to assess testicular cancer. This is assessment is known as giving the cancer a ‘clinical stage’. Categorising the cancer in this way is done using the TNM system which is explained below.
With testicular cancer, staging can only take place after an orchidectomy procedure.
| TNM Code | What it Means |
|---|---|
| T | Stands for Tumour size. |
| Tis | Testicular Carcinoma in Situ. Cancer cells are in the testes (testicles) but they have not invaded the surrounding testicular tissue. |
| T1 | Tumour confined to testicle and epididymis |
| T2 | Tumour has begun to infiltrate the blood vessels or lymph nodes close to the testicle. |
| T3 | Tumour has grown as far as the spermatic cord and possibly blood vessels and lymph nodes. |
| T4 | Tumour has invaded the scrotum. |
| TNM Code | What it Means |
|---|---|
| N | Stands for Lymph Nodes |
| N0 | Lymph nodes do not contain cancer cells. |
| N1 | Lymph nodes are smaller than 2cm wide. |
| N2 | At least one lymph node is larger than 2cm but smaller than 5cm wide. |
| N3 | At least one affected lymph node is bigger than 5cm. |
| TNM Code | What it Means |
|---|---|
| M | M stands for Metastases. Metastases are deposits of cancer which form because the primary cancer has travelled to other organs in the body or bones. They are sometimes referred to as ‘secondaries’. Testicular cancer which has spread from its primary site in this way tends to be deposited in the lungs, liver or brain. |
| M0 | There is no evidence that the cancer has spread to other organs. |
| M1a | The cancer has spread to the lungs or distant lymph nodes furthest away from the testicle. |
| M1b | Organs such as the liver or brain have been affected. |
Staging Using Tumour Markers
A further way of categorising testicular cancer is to measure the tumour markers in stages. This method, combined with those described above, is the best way to predict possible treatment success.
| Code | Tumour Marker Level |
|---|---|
| S | Stands for Serum Markers |
| S0 | Tumour marker levels within normal limits |
| S1 | LDH < 1.5 X Normal and HCG < 5,000 and AFP < 1,000 |
| S2 | LDH 1.5-10 X Normal or HCG 5,000-50,000 or AFP 1,000-10,000 |
| S3 | LDH > 10 X Normal or HCG > 50,000 or AFP > 10,000 |