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 measured prior to orchiectomy, but levels after orchiectomy are used for assignment of S category .... Stage grouping classification of Stage IS requires persistent elevation of serum tumor markers following orchiectomy." (* corrected in erratum)
  • 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

*Erratum: AJCC 5th reprint corrected pages

Older staging systems[edit]

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