Introduction

Staging testicular cancer is the best way to determine if there is a presence of cancer in the testis, and also to know if it has spread. Medical doctors who are responsible for the treatment of cancers (Urologists) use various diagnostic tests e.g., imaging test such as CT scans, x-rays; and blood tests to determine testicular cancer stages, that is why staging testicular cancer won’t be complete without a full or completer diagnosis.

Staging also help medical scientists to know how serious testicular cancer is and how best to treat them. It also enables them to determine the survival rate of each diagnosed patients (prognosis).

Just like other type of cancer, testicular cancer starts from stage 0 which is also referred to as The Germ Cell Neoplasia in Situ or GCNIS. Testicular cancer stage grouping starts from 1 (I) through 3 (III), but unlike some other form of cancers, has no stage 4 (IV). And these stages are further divided into alphabets such as A, B, C etc., so as to show some extra details. The lower the number, the lesser the cancer has spread, and the higher the number, the farther the cancer has spread to other part of the body. Although people experience different symptoms, yet the outlook and treatment plan for testicular cancer are the same.

Determining Testicular Cancer Stages

For testicular cancer, there are different staging descriptions, although the widely used staging system for testicular cancer is the American Joint Committee on Cancer (AJCC) called the TNM system. Staging for testicular cancer can also be Clinical or Pathological.

Clinical Staging: This staging is usually determined as a result of tests carried out other than biopsy (i.e., physical examinations and imaging tests).

Pathological Staging: This staging is determined based on findings during surgery. For example, pathological stage II testicular cancer means that cancer was found in tissues removed from some lymph nodes. So, unlike clinical staging, pathological staging gives information that helps determine a patient’s survival rate, yet not always needed.

TNM Staging System

The TNM staging system is the most widely used cancer staging system, but for testicular cancer, a S is added to the TNM system. This is done so as to determine the serum (blood) level of the tumor markers.

Tumor (T): Represented by the letter “T”, is used to describe the size and location of the tumor, and these tumors are usually measured in centimeters (roughly equals to the size of a pencil). Whenever the “T” is represented by a number, this signifies how larger the size of the tumor had become.

Also, for testicular cancer, the “T” can only be determined after tissues has been removed during surgery, and that makes the “T” staging a pathological stage and not a clinical stage.

Node (N): The “N” in the TNM staging system means lymph nodes. The lymph is a fluid that flows from various tissues and organs of the body. Cancer cells often build up, growing in these lymph nodes before spreading to other parts of the body. The “N” helps to determine if the testicular cancer cells have spread to nearby lymph nodes.

Also, for testicular cancer, lymph nodes are not removed or biopsied, but rather determined by imaging tests (CT scans), and this makes the “N” stage to be classed as a clinical staging rather than a pathological stage.

Metastasis (M): The “M” in the TNM staging system helps to describe the distant to which the cancer has spread to other parts of the body. The most commonly place where testicular cancer spreads are usually the lymph of the chest nodes, lungs, pelvis and the base of the neck. It is only in an advanced testicular stage that it spreads to the liver and bones; and in rare cases – the brain.

Serum Tumor Markers (S): The “S” represents the serum tumor markers in testicular cancer TNM staging system. Unlike other cancers, serum tumor markers help to stage testicular cancer better, this is because it allows medical doctors know the blood levels before and after the surgical removal of the testicle(s). Also, the “S” helps to determine if the tumor markers level is on the increase or normal.

Testicular Cancer Stage Grouping

Stage 0

This stage is also referred to as the “Germ Cell Neoplasia in Situ (GCNIS)”. In this stage, there is no real cancer but just warnings about the potential growth of cancer.

Stage I

At this stage, there is only the presence of cancer in the testicles, and it has not spread to the lymph nodes. At this stage, testicular cancer can be at any “T” level.

• Stage IA: The cancer is only in the testicle, grown in the rete testis, but not in the epididymis, hilar soft tissues, or blood vessels in the testis.
• Stage IB: In this stage, the cancer cells have grown into the epididymis, hilar soft tissues, tunica vaginalis, blood vessels within the testicles or the scrotum
• Stage IS: In this stage, the cancer is at any “T” stage, and has not spread to any lymph nodes or distant sites.

Stage II

When testicular cancer advances to this stage, it means the cancer cells have spread to one or few nearby lymph nodes but not lymph nodes of other parts of the body or distant organs.

• Stage IIA: This stage means cancer cells has spread into the retroperitoneal lymph nodes (nearby lymph nodes) but not bigger than 2cm.
• Stage IIB: This stage means cancer cells in the retroperitoneum, and the largest lymph node of the cancer cell is between 2cm – 5cm.
• Stage IIIC: At this stage, the cancer cells have spread to at least 1 lymph nodes that is larger than 5cm. Also, the cells have not spread outside the retroperitoneum.

Stage III

The moment testicular cancer reaches this stage, it means the cancer has spread beyond the lymph nodes, and could be found in other or distant lymph nodes or the lungs; and not only in the testicles. At this stage, the serum tumor markers level is very high and relatively unknown.

• Stage IIIA: In this stage, cancer cells have spread to distant lymph nodes and/or in the lungs. Here, the serum tumor marker levels are usually normal or mildly increased.
• Stage IIIB: The cancer cells at this stage have spread to any other lymph nodes and/or the lungs but not yet to any other organs.
• Stage IIIC: In this stage, the serum tumor markers level is extremely high, with the cancer spreading to at least 1 lymph nodes or organ. Also, the cancer has spread to other organs other than the lungs.

Recurrent Testicular Cancer

A recurrent testicular cancer is a cancer that occurs after treatment has been completed. Whenever this happen, tests are usually done all-over so as to learn about the extent of re-occurring.

PROGNOSIS

For testicular cancer, knowing the survival rate usually give the percentage of people with the same stage and type of cancer who are still alive over a period of time (usually 5 years) after diagnosis.

The survival rate of people living with testicular cancer are determined by the age, overall health conditions, type of testicular cancer, and how well the body responds to treatment plan, which ultimately determine the patient’s outlook.

Determining the survival rate by medical doctors, testicular cancer is grouped into localized, regional and distant form of staging instead of the TNM staging system.

• Localized: This is when the cancer cells are only present in the testis and have not spread.
• Regional: This is when cancer has reached the lymph nodes in the abdomen but not other parts of the body.
• Distant: The cancer has spread to tother parts of the body, such as the lungs, liver, brain and bones.

[Next Article: Treatment of Testicular Cancer]

References: American Cancer Society; WHO; WebMD, Cancer.net

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