Seminoma Testicular Cancer Staging

Except for Tis confirmed by biopsy and T4, the extent of the primary tumor is classified by radical orchiectomy, so a pathologic stage is assigned.

Primary tumor — pathologic staging (pT)

pTX

Primary tumor cannot be assessed

pT0

No evidence of primary tumor

Tis

Germ cell neoplasia in situ

pT1

Tumor limited to the testis (including rete testis invasion) without lymphovascular invasion

pT1a

Tumor < 3 cm

pT1b

Tumor ≥ 3 cm

pT2

Tumor limited to the 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 the scrotum with or without lymphovascular invasion

Regional lymph nodes — clinical (cN) staging

cNX

Regional lymph nodes cannot be assessed

cN0

No regional lymph node metastasis

cN1

Metastasis 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 not > 5 cm in greatest dimension or multiple lymph nodes, any one mass > 2 cm but not > 5 cm in greatest dimension

cN3

Metastasis with a lymph node mass > 5 cm in greatest dimension

Regional lymph nodes — pathologic (pN) staging

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 not > 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 metastases

M1

Distant metastasis

M1a

Non-retroperitoneal nodal or pulmonary metastases

M1b

Non-pulmonary visceral metastases

SX

Marker studies not available or not performed

S0

Marker study levels within normal limits

S1

Lactate dehydrogenase (LDH) level < 1.5 times upper limit of normal (ULN), human chorionic gonadotropin (HCG) level < 5000 IU/L, alpha-fetoprotein (AFP) level < 1000 ng/mL

S2

LDH 1.5–10 × ULN or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1000–10,000

S3

LDH > 10 × ULN or hCG (mIU/mL) >50,000

Stage

T

N

M

S (tumor markers)

0

pTis

N0

M0

S0

I

pT1–4

N0

M0

SX

IA

pT1

N0

M0

S0

IB

pT2–4

N0

M0

S0

IS

Any pT/TX

N0

M0

S1-3

II

Any pT/TX

N1-3

M0

SX

IIA

Any pT/TX

N1

M0

S0

Any pT/TX

N1

M0

S1

IIB

Any pT/TX

N2

M0

S0

Any pT/TX

N2

M0

S1

IIC

Any pT/TX

N3

M0

S0

Any pT/TX

N3

M0

S1

III

Any pT/TX

Any N

M1

SX

IIIA

Any pT/TX

Any N

M1a

S0

Any pT/TX

Any N

M1a

S1

IIIB

Any pT/TX

N1-3

M0

S2

Any pT/TX

Any N

M1a

S2

IIIC

Any pT/TX

N1-3

M0

S3

Any pT/TX

Any N

M1a

S3

Any pT/TX

Any N

M1b

Any S