Testicular cancer staging: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}} {{G.D.}}, {{SC}} | {{CMG}}; {{AE}} {{G.D.}}, {{SC}} | ||
{{Testicular cancer}} | {{Testicular cancer}} | ||
==Overview== | ==Overview== | ||
The diagnostic study of choice for testicular cancer is scrotal ultrasound. | The [[diagnostic]] study of choice for testicular cancer is scrotal [[ultrasound]]. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
*The diagnostic study of choice for testicular cancer is scrotal ultrasound.<ref name="pmid3072643">{{cite journal |vauthors=Benson CB |title=The role of ultrasound in diagnosis and staging of testicular cancer |journal=Semin Urol |volume=6 |issue=3 |pages=189–202 |date=August 1988 |pmid=3072643 |doi= |url=}}</ref><ref name="pmid2163557">{{cite journal |vauthors=Marth D, Scheidegger J, Studer UE |title=Ultrasonography of testicular tumors |journal=Urol. Int. |volume=45 |issue=4 |pages=237–40 |date=1990 |pmid=2163557 |doi=10.1159/000281715 |url=}}</ref> | *The [[diagnostic]] study of choice for testicular cancer is scrotal [[ultrasound]].<ref name="pmid3072643">{{cite journal |vauthors=Benson CB |title=The role of ultrasound in diagnosis and staging of testicular cancer |journal=Semin Urol |volume=6 |issue=3 |pages=189–202 |date=August 1988 |pmid=3072643 |doi= |url=}}</ref><ref name="pmid2163557">{{cite journal |vauthors=Marth D, Scheidegger J, Studer UE |title=Ultrasonography of testicular tumors |journal=Urol. Int. |volume=45 |issue=4 |pages=237–40 |date=1990 |pmid=2163557 |doi=10.1159/000281715 |url=}}</ref><ref name="pmid29262668">{{cite journal |vauthors=Boccellino M, Vanacore D, Zappavigna S, Cavaliere C, Rossetti S, D'Aniello C, Chieffi P, Amler E, Buonerba C, Di Lorenzo G, Di Franco R, Izzo A, Piscitelli R, Iovane G, Muto P, Botti G, Perdonà S, Caraglia M, Facchini G |title=Testicular cancer from diagnosis to epigenetic factors |journal=Oncotarget |volume=8 |issue=61 |pages=104654–104663 |date=November 2017 |pmid=29262668 |pmc=5732834 |doi=10.18632/oncotarget.20992 |url=}}</ref> | ||
==Staging== | ==Staging== | ||
*Testicular cancer may be classified into several subtypes based on the [[TNM system]] and the [[American Joint Committee on Cancer]] (AJCC). | *Testicular cancer may be classified into several subtypes based on the [[TNM system]] and the [[American Joint Committee on Cancer]] (AJCC). | ||
The [[American Joint Committee on Cancer]] (AJCC) includes serum [[tumor marker]] levels in the stages for [[germ cell tumors]]. Doctors use '''S''' to describe the levels of serum tumor markers in the blood after surgery to remove the [[testicle]]. The serum tumor markers measured are [[alpha-fetoprotein]] (AFP), [[human chorionic gonadotropin]] (HCG), and [[lactate dehydrogenase]] (LDH).<ref name="urlTesticular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/testicular/hp/testicular-treatment-pdq#_721 |title=Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref> | The [[American Joint Committee on Cancer]] (AJCC) includes [[serum]] [[tumor marker]] levels in the stages for [[germ cell tumors]]. Doctors use '''S''' to describe the levels of [[Tumor markers|serum tumor markers]] in the [[blood]] after [[surgery]] to remove the [[testicle]]. The [[serum]] [[tumor markers]] measured are [[alpha-fetoprotein]] (AFP), [[human chorionic gonadotropin]] (HCG), and [[lactate dehydrogenase]] (LDH).<ref name="urlTesticular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/testicular/hp/testicular-treatment-pdq#_721 |title=Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref> | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center | {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center" | ||
! valign="top" | | |||
|+ | |+ | ||
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| Stage}} | ! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| Stage}} | ||
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Description}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Description}} | ||
|- | |- | ||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Stage 0 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pTis<sup>b</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pTis<sup>b</sup> | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Germ cell neoplasia in situ | | style="padding: 5px 5px; background: #F5F5F5;" |[[Germ cells|Germ cell]] [[neoplasia]] [[in situ]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |N0 | | style="padding: 5px 5px; background: #F5F5F5;" |N0 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |cNO No regional lymph node [[metastasis]] | | style="padding: 5px 5px; background: #F5F5F5;" |cNO No [[Lymph node|regional lymph node]] [[metastasis]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |N0 | | style="padding: 5px 5px; background: #F5F5F5;" |N0 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pNO No regional lymph node [[metastasis]] | | style="padding: 5px 5px; background: #F5F5F5;" |pNO No [[Lymph nodes|regional lymph node]] [[metastasis]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |M0 | | style="padding: 5px 5px; background: #F5F5F5;" |M0 | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |SO | | style="padding: 5px 5px; background: #F5F5F5;" |SO | ||
| style="padding: 5px 5px; background: #F5F5F5;" |SO Marker study levels within normal limits | | style="padding: 5px 5px; background: #F5F5F5;" |SO [[Marker]] study levels within normal limits | ||
|- | |- | ||
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage I | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1 | | style="padding: 5px 5px; background: #F5F5F5;" |pT1 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] limited to [[testis]] (including [[Rete testis|rete testis invasion]]) without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>b</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>b</sup> | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor <3 cm in size | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] <3 cm in size | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup> | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor ≥3 cm in size | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] ≥3 cm in size | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT2 | | style="padding: 5px 5px; background: #F5F5F5;" |pT2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] limited to [[testis]] (including [[Rete testis|rete testis invasion]]) with lymphovascular invasion OR [[tumor]] invading hilar soft tissue or [[epididymis]] or penetrating [[visceral]] [[Mesothelial|mesothelia]]<nowiki/>l layer covering the external surface of [[Tunica albuginea (testicles)|tunica albuginea]] with or without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT3 | | style="padding: 5px 5px; background: #F5F5F5;" |pT3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] directly invades [[spermatic cord]] [[soft tissue]] with or without [[Vascular|lymphovascular]] invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT4 | | style="padding: 5px 5px; background: #F5F5F5;" |pT4 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor invades scrotum with or without lymphovascular invasion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] invades [[scrotum]] with or without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |cNO | | style="padding: 5px 5px; background: #F5F5F5;" |cNO | ||
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis. | | style="padding: 5px 5px; background: #F5F5F5;" |No regional [[Lymph nodes|lymph node]] [[metastasis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pNO | | style="padding: 5px 5px; background: #F5F5F5;" |pNO | ||
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis. | | style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |MO | | style="padding: 5px 5px; background: #F5F5F5;" |MO | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |SX | | style="padding: 5px 5px; background: #F5F5F5;" |SX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Marker|Marker studies]] not available or not performed. | ||
|- | |- | ||
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" |Stage IA | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1 | | style="padding: 5px 5px; background: #F5F5F5;" |pT1 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] limited to [[testis]] (including [[Rete testis|rete testis invasion]]) without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>a</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>a</sup> | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor <3 cm in size | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] <3 cm in size | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup> | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor ≥3 cm in size | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] ≥3 cm in size | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |cNO | | style="padding: 5px 5px; background: #F5F5F5;" |cNO | ||
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis. | | style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pNO | | style="padding: 5px 5px; background: #F5F5F5;" |pNO | ||
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis. | | style="padding: 5px 5px; background: #F5F5F5;" |No regional [[Lymph nodes|lymph node]] [[metastasis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |MO | | style="padding: 5px 5px; background: #F5F5F5;" |MO | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits. | | style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits. | ||
|- | |- | ||
! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage IB | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pT2 | | style="padding: 5px 5px; background: #F5F5F5;" |pT2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] limited to testis (including [[Rete testis|rete testis invasion]]) with lymphovascular invasion OR tumor invading [[Hilar|hila]]<nowiki/>r soft tissue or [[epididymis]] or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |cN0 | | style="padding: 5px 5px; background: #F5F5F5;" |cN0 | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits. | | style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits. | ||
|- | |- | ||
! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage IS | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pTX | | style="padding: 5px 5px; background: #F5F5F5;" |pTX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed. | | style="padding: 5px 5px; background: #F5F5F5;" |Primary [[tumor]] cannot be assessed. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT0 | | style="padding: 5px 5px; background: #F5F5F5;" |pT0 | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pTis | | style="padding: 5px 5px; background: #F5F5F5;" |pTis | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Germ cell neoplasia in situ. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Germ cell]] [[neoplasia]] [[in situ]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1 | | style="padding: 5px 5px; background: #F5F5F5;" |pT1 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] limited to testis (including rete testis invasion) without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>b</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>b</sup> | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor 3 cm in size. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] 3 cm in size. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup> | | style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup> | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT2 | | style="padding: 5px 5px; background: #F5F5F5;" |pT2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] limited to [[testis]] (including rete testis invasion) with lymphovascular invasion OR [[tumor]] invading hilar soft tissue or [[epididymis]] or penetrating [[visceral]] [[mesothelial]] layer covering the external surface of [[Tunica albuginea (penis)|tunica albuginea]] with or without lymphovascular invasion. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |pT3 | | style="padding: 5px 5px; background: #F5F5F5;" |pT3 | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>c</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | | style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>c</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | ||
|- | |- | ||
! rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" |Stage II | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed. | | style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed. | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed. | | style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed. | ||
|- | |- | ||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIA | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed. | | style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed. | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | ||
|- | |- | ||
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIB | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |See above description. | | style="padding: 5px 5px; background: #F5F5F5;" |See above description. | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | ||
|- | |- | ||
! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIC | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |See above description. | | style="padding: 5px 5px; background: #F5F5F5;" |See above description. | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | ||
|- | |- | ||
! rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage III | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |See above description. | | style="padding: 5px 5px; background: #F5F5F5;" |See above description. | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed. | | style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed. | ||
|- | |- | ||
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIA | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" |See above description. | | style="padding: 5px 5px; background: #F5F5F5;" |See above description. | ||
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| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | | style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | ||
|- | |- | ||
| style="padding: 5px 5px; background: # | ! rowspan="13" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIB | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Any | | style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions | ||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |cN1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |cN2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |cN3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pN1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pN2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pN3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |M0 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |LDH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | |||
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any N | |||
| style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |M1a | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |LDH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |||
|- | |||
! rowspan="21" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIC | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | |||
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |cN1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |cN2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |cN3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pN1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pN2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |pN3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |M0 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>b</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | |||
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions. | |||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Any N | | style="padding: 5px 5px; background: #F5F5F5;" |Any N | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |M1a | | style="padding: 5px 5px; background: #F5F5F5;" |M1a | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |S3 | | style="padding: 5px 5px; background: #F5F5F5;" |S3 | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>b</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Any | | style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions. | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Any N | | style="padding: 5px 5px; background: #F5F5F5;" |Any N | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |M1b | | style="padding: 5px 5px; background: #F5F5F5;" |M1b | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |Nonpulmonary visceral metastases. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |SX | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed. | ||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S0 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S1 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S2 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |DH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" |S3 | |||
| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>b</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |||
|} | |} | ||
Latest revision as of 10:19, 28 May 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]
Testicular cancer Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Testicular cancer staging On the Web |
American Roentgen Ray Society Images of Testicular cancer staging |
Risk calculators and risk factors for Testicular cancer staging |
Overview
The diagnostic study of choice for testicular cancer is scrotal ultrasound.
Diagnostic Study of Choice
- The diagnostic study of choice for testicular cancer is scrotal ultrasound.[1][2][3]
Staging
- Testicular cancer may be classified into several subtypes based on the TNM system and the American Joint Committee on Cancer (AJCC).
The American Joint Committee on Cancer (AJCC) includes serum tumor marker levels in the stages for germ cell tumors. Doctors use S to describe the levels of serum tumor markers in the blood after surgery to remove the testicle. The serum tumor markers measured are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH).[4]
Stage | TNM/S | Description |
---|---|---|
Stage 0 | pTisb | Germ cell neoplasia in situ |
N0 | cNO No regional lymph node metastasis | |
N0 | pNO No regional lymph node metastasis | |
M0 | No distant metastasis | |
SO | SO Marker study levels within normal limits | |
Stage I | pT1 | Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. |
pT1ab | Tumor <3 cm in size | |
pT1bb | Tumor ≥3 cm in size | |
pT2 | Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. | |
pT3 | Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | |
pT4 | Tumor invades scrotum with or without lymphovascular invasion. | |
cNO | No regional lymph node metastasis. | |
pNO | No regional lymph node metastasis. | |
MO | No distant metastasis. | |
SX | Marker studies not available or not performed. | |
Stage IA | pT1 | Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. |
pT1aa | Tumor <3 cm in size | |
pT1bb | Tumor ≥3 cm in size | |
cNO | No regional lymph node metastasis. | |
pNO | No regional lymph node metastasis. | |
MO | No distant metastasis. | |
S0 | Marker study levels within normal limits. | |
Stage IB | pT2 | Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. |
cN0 | No regional lymph node metastasis | |
pN0 | No regional lymph node metastasis | |
M0 | No distant metastasis | |
S0 | Marker study levels within normal limits. | |
pT3 | Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | |
cN0 | No regional lymph node metastasis | |
pN0 | No regional lymph node metastasis | |
M0 | No distant metastasis | |
S0 | Marker study levels within normal limits. | |
pT4 | Tumor invades scrotum with or without lymphovascular invasion. | |
cN0 | No regional lymph node metastasis | |
pN0 | No regional lymph node metastasis | |
M0 | No distant metastasis | |
S0 | Marker study levels within normal limits. | |
Stage IS | pTX | Primary tumor cannot be assessed. |
pT0 | No evidence of primary tumor. | |
pTis | Germ cell neoplasia in situ. | |
pT1 | Tumor limited to testis (including rete testis invasion) without lymphovascular invasion. | |
pT1ab | Tumor 3 cm in size. | |
pT1bb | Tumor ≥3 cm in size. | |
pT2 | Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion. | |
pT3 | Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion. | |
pT4 | Tumor invades scrotum with or without lymphovascular invasion. | |
cN0 | No regional lymph node metastasis. | |
pN0 | No regional lymph node metastasis. | |
M0 | No distant metastasis | |
S1 | LDH < 1.5 × Nc and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
S2 | LDH 1.5–10 × Nc or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
S3 | LDH > 10 × Nc or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |
Stage II | Any pT/TX | Primary tumor cannot be assessed/Marker studies not available or not performed. |
cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
M0 | No distant metastases. | |
SX | Marker studies not available or not performed. | |
Stage IIA | Any pT/TX | Primary tumor cannot be assessed/Marker studies not available or not performed. |
cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
M0 | No distant metastasis | |
S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
Stage IIB | Any pT/TX | See above description. |
cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
M0 | No distant metastases. | |
S0 | Marker study levels within normal limits. | |
pT/TX | See above description | |
cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
M0 | No distant metastases. | |
S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
Stage IIC | Any pT/TX | See above description. |
cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
M0 | No distant metastases. | |
S0 | Marker study levels within normal limits. | |
Any pT/TX | See above description. | |
cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
M0 | No distant metastasis | |
S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
Stage III | Any pT/TX | See above description. |
cNX | Regional lymph nodes cannot be assessed. | |
cN0 | No regional lymph node metastasis. | |
cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
pNX | Regional lymph nodes cannot be assessed. | |
pN0 | No regional lymph node metastasis. | |
pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
M1 | Distant metastases. | |
M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
M1b | Nonpulmonary visceral metastases. | |
SX | Marker studies not available or not performed. | |
Stage IIIA | Any pT/TX | See above description. |
Any N | See descriptions in this table, Stage III. | |
M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
S0 | Marker study levels within normal limits. | |
Any pT/TX | See above description. | |
Any N | See descriptions in this table, Stage III. | |
M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
Stage IIIB | Any pT/TX | See above descriptions |
cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
M0 | No distant metastases. | |
S2 | LDH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
Any pT/TX | See above descriptions | |
Any N | See descriptions in this table, Stage III. | |
M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
S2 | LDH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
Stage IIIC | Any pT/TX | See above descriptions. |
cN1 | Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension. | |
cN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension. | |
cN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
pN1 | Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension. | |
pN2 | Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor. | |
pN3 | Metastasis with a lymph node mass >5 cm in greatest dimension. | |
M0 | No distant metastases. | |
S3 | LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |
Any pT/TX | See above descriptions. | |
Any N | See descriptions in this table, Stage III. | |
M1a | Nonretroperitoneal nodal or pulmonary metastases. | |
S3 | LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. | |
Any pT/TX | See above descriptions. | |
Any N | See descriptions in this table, Stage III. | |
M1b | Nonpulmonary visceral metastases. | |
SX | Marker studies not available or not performed. | |
S0 | Marker study levels within normal limits. | |
S1 | LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000. | |
S2 | DH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000. | |
S3 | LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000. |
References
- ↑ Benson CB (August 1988). "The role of ultrasound in diagnosis and staging of testicular cancer". Semin Urol. 6 (3): 189–202. PMID 3072643.
- ↑ Marth D, Scheidegger J, Studer UE (1990). "Ultrasonography of testicular tumors". Urol. Int. 45 (4): 237–40. doi:10.1159/000281715. PMID 2163557.
- ↑ Boccellino M, Vanacore D, Zappavigna S, Cavaliere C, Rossetti S, D'Aniello C, Chieffi P, Amler E, Buonerba C, Di Lorenzo G, Di Franco R, Izzo A, Piscitelli R, Iovane G, Muto P, Botti G, Perdonà S, Caraglia M, Facchini G (November 2017). "Testicular cancer from diagnosis to epigenetic factors". Oncotarget. 8 (61): 104654–104663. doi:10.18632/oncotarget.20992. PMC 5732834. PMID 29262668.
- ↑ "Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute".