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.

Cancer doctors use a variety of diagnostic tests to evaluate testicular cancer and develop an individualized treatment plan. If a patient has been recently diagnosed, the care team will review his pathology to confirm that he received the correct diagnosis and staging information and develop a personalized treatment plan. If patients experience a recurrence, the care team will perform comprehensive testing and identify a treatment approach suited to the patient's needs.

How is testicular cancer staged?

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, 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.

Stages of testicular cancer

There are three stages of testicular cancer.

Stage 0

The cancer cells have not spread beyond the testicle. In stage 0 testicular cancer, 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.

Stage 4 testicular cancer

Although stage 4 cancers are common with other cancer types, there is no stage 4 testicular cancer, making stage 3 the highest testicular cancer stage.

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 a patient is in remission (no evidence of cancer), he should still 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 the care team should advise each patient on the right schedule for him.

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.

Testicular cancer survival rate

One method of estimating life expectancy when battling cancer is to review the five-year relative survival rate for that cancer type. A five-year relative survival rate indicates the likelihood that a person with a specific type and stage of cancer may live for at least five years after the diagnosis, compared with people who don't have cancer. The rate includes the life expectancy of patients who are still in treatment and those who have finished treatment and have no further evidence of disease. Overall, the five-year relative survival rate for testicular cancer is about 95 percent.

The National Cancer Institute SEER Program further bases the five-year relative survival rate for testicular cancer on how far the cancer has spread.

• Localized—The cancer has not spread beyond the testicles. The five-year survival rate for localized testicular cancer is about 99 percent.
• Regional—The cancer has spread from the testicular area to nearby lymph nodes or structures. The five-year survival rate for regional testicular cancer is about 96 percent.
• Distant—The testicular cancer has spread to structures that are further away from the testicles, such as the liver. The five-year survival rate for distant testicular cancer is about 73 percent.