Seminoma Testicular Cancer Staging
Updated: Jan 29, 2022
Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD
The tumor-node-metastasis (TNM) classification for seminoma testicular cancer is provided below.[1]
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pT1
Table. TNM Classification for Seminoma Testicular Cancer (Open Table in a new window)
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 |
Table. Serum tumor markers (S) (Open Table in a new window)
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 |
Table. Anatomic stage/prognostic groupings (Open Table in a new window)
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 |