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