Testicular cancer stages

Making an educated treatment decision begins with the stage, or progression, of the disease. The stage of testicular cancer is one of the most important factors in evaluating treatment options.

At Cancer Treatment Centers of America^® (CTCA), our cancer doctors use a variety of diagnostic tests to evaluate testicular cancer and develop an individualized treatment plan. If you have been recently diagnosed, we will review your pathology to confirm you’ve received the correct diagnosis and staging information and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach suited to your needs.

Testicular cancer staging describes how large a cancer is, whether the disease has spread and whether it is producing tumor markers, in addition to noting the level of those proteins in the serum, or blood. The TNM staging guidelines developed by the American Joint Committee on Cancer are often used in testicular cancer staging.

The stages are based on four categories:

T (tumor): This describes whether the tumor has spread to tissues near the testicle.

N (node): This indicates whether the testicular cancer cells have spread to regional lymph nodes.

M (metastasis): This refers to whether the cancer has metastasized (spread to distant areas of the body).

S (serum): This indicates the level of tumor marker proteins in the serum, or blood.

Once the individual T, N, M and S components are scored, they are combined to determine the overall testicular cancer stage group. The stages of testicular cancer are:

Stage 0: The cancer cells have not spread beyond the testicle. At this stage, tumors are also referred to as carcinomas in situ.

Stage 1 testicular cancer: The cancer has invaded tissues next to the testicle, but has not spread to lymph nodes, or more distant sites in the body. Levels of tumor marker proteins may be normal or elevated. The three subcategories of stage 1 testicular cancer are:

• Stage 1A: The tumor may have grown through the inner layer of tissue surrounding the testicle, but not the outer layer, and it has not spread to blood or lymph vessels. Serum levels of tumor markers are normal.
• Stage 1B: Tumors at this stage may have spread to blood or lymph vessels or may have invaded the outer layer surrounding the testicle, the spermatic cord or the scrotum. Serum levels of tumor markers are normal.
• Stage 1S: These cancers can demonstrate any degree of invasion of nearby tissues, and levels of tumor markers measured after the tumor has been removed by surgery are elevated.

Stage 2 testicular cancer: Testicular cancers at this stage have invaded tissues next to the testicle and can now be found in at least one nearby lymph node. Tumor marker levels may be normal or slightly elevated. Stage 2 testicular cancer has three subcategories:

• Stage 2A: Tumors at this stage have spread to one or more lymph nodes, but no node is larger than 2 cm.
• Stage 2B: Tumors at this stage have spread to at least one lymph node, which is between 2 cm and 5 cm in size.
• Stage 2C: These tumors have spread to at least one lymph node that is larger than 5 cm.

Stage 3 testicular cancer: Testicular cancers at this stage have spread to distant lymph nodes or organs. Stage 3 testicular cancer has three subcategories:

• Stage 3A: These cancers have spread to a distant lymph node or the lungs. Tumor marker protein levels are normal or slightly elevated.
• Stage 3B: At this stage of testicular cancer, patients have moderately elevated levels of tumor marker proteins, and the disease has either spread to nearby or distant lymph nodes, or the lungs.
• Stage 3C: These cancers have high levels of tumor marker proteins and may have spread to nearby or distant lymph nodes, or the lungs. Alternatively, they may have spread to other distant organs, such as the liver or the brain, but in this case serum tumor markers can be at any level.

Recurrent testicular cancer

Sometimes, testicular cancer returns after treatment has concluded. This is called recurrent testicular cancer. Cancer may come back:

• In the original location (testicles)
• Near the testicles
• In another part of the body

If you’re in remission (no evidence of cancer), you still need to schedule regular exams to ensure the cancer hasn’t returned. Follow-up exams are likely to be most frequent in the first two years after treatment concludes, but your doctor should advise you on the right schedule for you.

If the cancer returns, doctors may order another round of testing for diagnosis and staging. The tests resemble those done to diagnose and stage the original cancer. In some cases, cancer recurs long after the initial treatment. However, if nonseminoma testicular cancer returns, it’s usually within two years. Seminoma testicular tumor recurrences tend to occur within three years.