Radiation Oncology/Testis/Staging

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AJCC 7th Edition (2009)
Primary Tumor:

  • T1 - limited to testis and epididymis without vascular/lymphatic invasion; may invade into the tunica albuginea but not the tunica vaginalis
  • T2 - limited to testis and epididymis with vascular/lymphatic invasion; or tumor involving the tunica vaginalis
  • T3 - invades the spermatic cord
  • T4 - invades the scrotum


Regional Lymph Nodes:

Regional nodes: para-aortic, interaortocaval, para/pre/retrocaval, pre/retroaortic LN
Intrapelvic, external iliac, and inguinal LN are considered regional only after scrotal or inguinal surgery.
Clinical:
  • N1 - lymph node mass 2 cm or less in greatest dimension; or multiple lymph nodes, none more than 2 cm in greatest dimension
  • N2 - lymph node mass 2 - 5 cm; or multiple lymph nodes, any one mass 2 - 5 cm
  • N3 - lymph node mass > 5 cm
Pathologic:
  • N1 - lymph node mass 2 cm or less in greatest dimension, and <= 5 nodes positive, none more than 2 cm in greatest dimension
  • N2 - lymph node mass 2 - 5 cm; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension
  • N3 - lymph node mass > 5 cm


Distant Metastases:

  • M1a - non-regional nodal or pulmonary mets
  • M1b - other distant mets


Serum tumor markers (S):

  • Note: (from the AJCC Staging Manual, 7th Edition) "Serum tumor markers ... should be obtained prior to orchiectomy to complete the status of the serum tumor markers (S). The only exception is for Stage IS in which persistent elevation of serum tumor markers following orchiectomy is required."
  • S0 - serum markers within normal limits
  • S1 - LDH < 1.5 * upper limit of normal, AND hCG < 5000 mIu/mL, AND AFP < 1000 ng/mL
  • S2 - LDH 1.5 - 10 * normal range, OR hCG 5000-50,000, OR AFP 1000-10,000
  • S3 - LDH > 10 * normal range, OR hCG >50,000, OR AFP > 10,000


Stage Grouping:

  • IA - T1 N0 M0 S0
  • IB - T2-4 N0 M0 S0
  • IS - Any T N0 M0 S1-3
  • IIA - Any T N1 M0 S0-1
  • IIB - Any T N2 M0 S0-1
  • IIC - Any T N3 M0 S0-1
  • IIIA - Any T Any N M1a S0-1
  • IIIB - S2 and either N1-3 or M1a
  • IIIC - S3 and either N1-3 or M1a; or M1b

Older staging systems[edit]

AJCC 6th Edition (2002)
No changes compared to 7th Edition