Nonseminoma Testicular Cancer Staging 

Updated: Jan 17, 2014
  • Author: Kush Sachdeva, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
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TNMS Classification for Nonseminoma Testicular Cancer

The TNMS classification for staging of nonseminoma testicular cancer is provided below. [1] This classification is based on the TNM system; the S is a parameter used only for testicular cancer.

Table. TNMS Classification for Nonseminoma Testicular Cancer (Open Table in a new window)

Primary tumor (pT)
Extent of primary tumor is usually classified after radical orchiectomy, and for this reason, a pathologic stage is assigned
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Intratubular germ cell neoplasia
T1 Tumor limited to the testis and epididymis or tumor invasion into the tunica albuginea only
T2 Tumor extending through the tunica albuginea with involvement of the tunica vaginalis
T3 Tumor invades the spermatic cord
T4 Tumor invades the scrotum
Regional lymph nodes (N)
Clinical
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis with a lymph node mass ≤ 2 cm in greatest dimension; or multiple lymph nodes, none >2 cm in greatest dimension
N2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or multiple lymph nodes, any 1 mass >2 cm but ≤5 cm in greatest dimension
N3 Metastasis with a lymph node mass >5 cm in greatest dimension
Pathologic (pN)
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 >5 cm; or evidence of extranodal extension of tumor
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
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis
M1a Nonregional nodal or pulmonary metastasis
M1b Distant metastasis other than to nonregional lymph nodes and lungs

Table. Serum tumor markers (Open Table in a new window)

Serum tumor markers (S)
SX Marker studies not available or not performed
S0 Marker study levels within normal limits
S1 LDH < 1.5 × N*, hCG (mlU/mL) < 5000, AFP (ng/mL) < 1000
S2 LDH 1.5-10 × N*, hCG (mlU/mL) 5000-50,000, AFP (ng/mL) 1000-10,000
S3 LDH > 10 × N*, hCG (mlU/mL) >50,000, AFP (ng/mL) >10,000
AFP = alpha-fetoprotein; hCG = human chorionic gonadotropin; LDH = lactate dehydrogenase; N* = upper limit of normal for LDH assay.

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M S
0 pTis N0 M0 S0
I pT1-4 N0 M0 SX
IA pT1 N0 M0 S0
IB pT2 N0 M0 S0
pT3 N0 M0 S0
pT4 N0 M0 S0
IS Any T N0 M0 S1-3
II Any T N1-3 M0 SX
IIA Any T N1 M0 S0
Any T N1 M0 S1
IIB Any T N2 M0 S0
Any T N2 M0 S1
IIC Any T N3 M0 S0
Any T N3 M0 S1
III Any T Any N M1 SX
IIIA Any T Any N M1a S0
Any T Any N M1a S1
IIIB Any T N1-3 M0 S2
Any T Any N M1a S2
IIIC Any T N1-3 M0 S3
Any T Any N M1a S3
Any T Any N M1b Any S