TNMS Classification for Nonseminoma Testicular Cancer
The tumor-node-metastasis–serum tumor markers (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) |
|
Except for biopsy-confirmed Tis and T4, the extent of primary tumor is classified after radical orchiectomy, and for this reason, a pathologic stage is assigned |
|
pTX |
Primary tumor cannot be assessed |
pT0 |
No evidence of primary tumor (eg, histologic scar in testis) |
pTis |
Intratubular germ cell neoplasia (carcinoma in situ) |
pT1 |
Tumor limited to the testis and epididymis without vascular/lymphatic invasion; tumor may invade into the tunica albuginea but not the tunica vaginalis—applies only to pure seminoma |
pT2 |
Tumor limited to the testis and epididymis with vascular/lymphatic invasion or tumor extending through the tunica albuginea with involvement of the tunica vaginalis |
pT3 |
Tumor invades the spermatic cord with or without vascular/lymphatic invasion |
pT4 |
Tumor invades the scrotum with or without vascular/lymphatic invasion |
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 |