Radiation Oncology/Testis/Staging

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

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