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Staging

Criteria for TNM Clinical Staging:
Physical examination and results of radical orchiectomy.

Criteria for TNM Pathologic Staging:
Extent of disease by histologic evaluation of radical orchiectomy specimen.

Note: evaluation of specimens from a defined node bearing area (such as retroperitoneal or periaortic) must be used. In other words, there must be a lymph node dissection for Pathologic Staging.

In the 6th edition of the AJCC staging manual, an additional descriptor, S (serum tumor markers) is required for stage grouping.

Brief Summaries of 6th Edition Categories

Tis Intratubular
pT1 Testis and epididymis, no vascular or lymphatic invasion
pT2 Testis and epididymis with vascular or lymphatic invasion, tunica vaginalis
pT3 Spermatic cord
pT4 Scrotum
N1 Nodal mass < 2 cm
N2 Nodal mass >2 but not more than 5 cm
N3 Any nodal mass > 5 cm
M1a Non-regional lymph node or pulmonary metastasis
M1b Distant metastasis other than to non-regional lymph nodes and lungs.
S1 LDH < 1.5 times normal AND hCG < 5,000 AND AFP < 1,000
S2 LDH 1.5-10 times normal OR hCG 5,000-50,000 OR AFP 1,000-10,000
S3 LDH > 10 times normal OR hCG > 50,000 OR AFP > 10,000

Collaborative Stage Elements

For more details on Collaborative Stage, see the Intro to Collaborative Staging module.