Testis and epididymis
Miscellaneous
Staging

Author: Swapnil U. Rane, M.D. (see Authors page)

Revised: 19 July 2017, last major update November 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Staging[title] testis

Cite this page: Staging. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisstaging.html. Accessed July 23rd, 2017.
Definition / general
  • Pathologic staging (pT) requires histologic examination
Primary tumor (T)
  • pTX: primary tumor cannot be assessed
  • pT0: no evidence of primary tumor (i.e. scar but no tumor in testis)
  • pTis: intratubular germ cell neoplasia ("carcinoma in situ" although not an epithelial lesion)
  • pT1: tumor limited to the testis and epididymis without vascular / lymphatic invasion; tumor may invade into the tunica albuginea but not the tunica vaginalis
  • pT2: tumor limited to the testis and epididymis with vascular / lymphatic invasion or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
  • pT3: tumor invades the spermatic cord with or without vascular / lymphatic invasion
  • pT4: tumor invades the scrotum with or without vascular / lymphatic invasion
Regional lymph nodes (N)
  • pNX: regional lymph nodes cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: metastasis with a lymph node mass 2 cm or less in greatest dimension and 5 or fewer positive lymph nodes, none more than 2 cm in greatest dimension
  • pN2: metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension; or 6 or more lymph nodes positive, none more than 5 cm in greatest dimension; or evidence of extranodal extension of tumor
  • pN3: metastasis with a lymph node mass more than 5 cm in greatest dimension
Distant metastasis (M)
  • M0: no distant metastasis
  • M1: distant metastasis
  • M1a: nonregional nodal or pulmonary metastasis
  • M1b: distant metastasis other than to nonregional lymph nodes and lungs
S classification (serum tumor markers)
  • SX: marker studies not available or not performed
  • S0: marker studies within normal limits
  • S1: LDH < 1.5 x upper limit of normal AND hCG < 5000 mIu/ml AND AFP < 1000 ng/ml
  • S2: LDH 1.5 - 10 x upper limit of normal OR hCG 5,000 - 50,000 mIu/ml OR AFP 1000 - 10,000 ng/ml
  • S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIu/ml OR AFP > 10,000 ng/ml

Notes:
  • Serum tumor markers are measured prior to orchiectomy for assignment of S category, except for Stage IS, in which persistent elevation of serum tumor markers following orchiectomy is required
  • Reference for LDH: Am J Clin Pathol 1982;78:178
TNM and S (serum tumor markers)
0:pTisN0M0S0 (stage 0 is no longer included in FIGO)
I:pT1 - 4N0M0SX
IA:pT1N0M0S0
IB:pT2 - 4N0M0S0
IS:any pT/TXN0M0S1 - 3 (measured postorchiectomy)
II:any pT/TXN1 - 3M0SX
IIA:any pT/TXN1M0S0 - 1
IIB:any pT/TXN2M0S0 - 1
IIC:any pT/TXN3M0S0 - 1
III:any pT/TXany NM1SX
IIIA:any pT/TXany NM1aS0 - 1
IIIB:any pT/TXN1 - 3 M0  S2  ORany pT/TXany NM1aS2
IIIC:any pT/TXN1 - 3M0S3ORany pT/TXany NM1aS3ORany Tany NM1bany S