Testicular Cancer: Stages

What does stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

What are the stages of testicular cancer?

Testicular cancer staging includes the traits of the primary tumor. It also considers whether your cancer has spread to your lymph nodes> Or it looks at whether your cancer has spread to your lungs or other organs. The staging system also takes into account the blood level of your tumor markers.

The TNM system

The International Union Against Cancer and the American Joint Committee on Cancer have developed a standard system of describing how much a cancer has grown. It is known as the TNM system.

In the TNM system:

  • The T says how far the main tumor has grown.

  • The N says whether the cancer has spread to lymph nodes in the area of your original tumor.

  • The M says whether your cancer has spread (metastasized) to other organs in the body.

  • In addition, the letter S shows the serum levels of certain tumor markers in your body that some testicular cancers make. These markers are AFP, HCG, and LDH. The blood tests done after surgery to remove the testicle are used for staging purposes. When chemotherapy is used for metastatic cancer, the marker levels on the first day of chemotherapy are the values recorded for staging. 

Numbers after each of these letters provide more details about each piece of information. 

Once a man's T, N, M, and S factors have been determined, a doctor puts this information together in what is called stage grouping. Stage grouping is used to find out your overall cancer stage. It is listed as numbers. Stage I is the earliest stage. Stage III is the most advanced stage. The letter after the numeral further tells the cancer. For example, Stage IIC.

Stage 0. Stage 0 is a cancer that has not spread beyond the tiny tubules where the sperm cells begin to develop. This is also called carcinoma in situ.

Stage I. For this stage, the main tumor (T) can be any level. The cancer has not spread to the lymph nodes (N0) or distant parts of the body (M0). Serum tumor marker levels are not available (SX).

Stage IA. Cancer is only in the testicle and has not invaded the lymphatic or blood vessels in the testicle. The tumor may have invaded the inner membrane surrounding the testis (the tunica albuginea) but not the outer membrane (the tunica vaginalis) (T1). The cancer has not spread to lymph nodes (N0) or distant sites (M0). Serum tumor markers are normal after the cancerous testicle is removed (S0).

Stage IB. The tumor may have grown further into or outside of the testicle (T2, T3, or T4). But the cancer has not spread to lymph nodes (N0) or distant sites (M0). Serum tumor markers are normal after the cancerous testicle is removed (S0).

Stage IS. The tumor may or may not have grown outside of the testicle (any T). But the cancer has not spread to lymph nodes (N0) or distant sites (M0). Serum tumor markers are abnormal, even after the cancerous testicle is removed (S1, S2, or S3).

Stage II: The tumor may or may not have grown outside of the testicle (any T). The cancer has spread to nearby lymph nodes (N1, N2, or N3). But it has not spread to lymph nodes in other parts of the body or distant organs (M0). Serum tumors markers are not available (SX).

Stage IIA: The tumor may or may not have grown outside of the testicle (any T). The cancer has spread to 5 or fewer nearby lymph nodes. None of these is larger than 2 centimeters across (N1). The cancer has not spread to lymph nodes in other parts of the body or distant organs (M0). Serum tumor markers are either normal (S0) or slightly higher (S1) after the cancerous testicle is removed.

Stage IIB: The tumor may or may not have grown outside of the testicle (any T). The cancer has spread to nearby lymph nodes. At least one of these is 2 centimeters to 5 centimeters across. Or the cancer has spread to more than 5 lymph nodes. None of these is more than 5 centimeters across (N2). The cancer has not spread to lymph nodes in other parts of the body or distant organs (M0). Serum tumor markers are either normal (S0) or slightly higher (S1) after the cancerous testicle is removed.

Stage IIC: The tumor may or may not have grown outside of the testicle (any T). The cancer has spread to nearby lymph nodes. At least one of these is larger than 5 centimeters across (N3). The cancer has not spread to lymph nodes in other parts of the body or distant organs (M0). Serum tumor markers are either normal (S0) or slightly higher (S1) after the cancerous testicle is removed.

Stage III: The tumor may or may not have grown outside of the testicle (any T) and may or may not have reached nearby lymph nodes (any N). Cancer has spread to lymph nodes in other parts of the body or to distant organs (M1). Serum tumor marker levels are not known (SX).

Stage IIIA: The tumor may or may not have grown outside of the testicle (any T) and may or may not have reached nearby lymph nodes (any N). Cancer has spread to lymph nodes in other parts of the body or to the lungs (M1a). Serum tumor markers are either normal (S0) or slightly higher (S1) after the cancerous testicle is removed.

Stage IIIB: The tumor may or may not have grown outside of the testicle (any T). At least one serum tumor marker is much higher (S2) after the cancerous testicle is removed. The cancer has spread to nearby lymph nodes (N1, N2, or N3). Or it has spread to lymph nodes in other parts of the body or to the lungs (M1a).

Stage IIIC: The tumor may or may not have grown outside of the testicle (any T), and one of the following applies:

  • At least one serum tumor marker is much higher (S3) after the cancerous testicle is removed. The cancer has spread to nearby lymph nodes (N1, N2, or N3). Or it has spread to lymph nodes in other parts of the body or to the lungs (M1a).

  • The cancer has spread to distant organs other than the lungs, such as the liver, brain, or bones (M1b).

For testicular cancers that have spread outside the testicles, doctors also use risk groups. Based on your risk group, your doctors can decide on the best treatment choices for you. These risk groups depend on whether the cancer is a seminoma or nonseminoma. They also depend on the extent and location of the cancer, and serum tumor marker levels. 

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.