Nonseminoma Testicular Cancer Staging

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

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.

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