Staging
Staging is a process that tells the doctor if the cancer has spread and if it has, how far. Staging for testicular cancer also depends on the levels of tumor markers in the blood. The stage is an important step in evaluating treatment options.
Stage 0 (carcinoma in situ)
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Description
- Abnormal, but non-invasive cells are found in the tubules where sperm cells form. All tumor marker levels are normal.
Treatment
- Surgery (Orchiectomy), radiation therapy, active surveillance.
Stage Ia
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Description
- Cancer found in the testicle and the epididymis, a tube in the back of the testicle. Cancer may be found in the inner layer of the testicular membrane. All tumor markers normal.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by RPLND, chemotherapy, or active surveillance.
- Seminoma: Surgery (Orchiectomy), followed by radiation to the lymph nodes in the abdomen, chemotherapy, or active surveillance.
Stage Ib
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Description
- Cancer found in one of the following places. All tumor marker levels are normal.
- A testicle, the epididymis, and blood vessels or lymph vessels in the testicle.
- The outer layer of the testicular membrane.
- The spermatic cord, scrotum, blood vessels, or lymph vessels.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by RPLND, chemotherapy or active surveillance.
- Seminoma: Surgery (Orchiectomy), followed by radiation to the lymph nodes in the abdomen, chemotherapy, or active surveillance.
Stage Is
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Description
- Cancer found in the testicle, spermatic cord, or scrotum. Either all tumor markers are slightly elevated, or one or more tumor markers are moderately elevated.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by chemotherapy, RPLND, or active surveillance. If tumor markers return to normal after surgery to remove the testicle, active surveillance can still be pursued.
- Seminoma: Surgery (Orchiectomy), followed by radiation therapy if tumor markers remain elevated.
Stage IIa
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Description
- Cancer found in the testicle, spermatic cord, or scrotum and in as many as five abdominal lymph nodes. None of the lymph nodes is bigger than 2 cm. Tumor markers may be normal or slightly elevated.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by RPLND or chemotherapy.
- Seminoma: Surgery (Orchiectomy), followed by radiation to the lymph nodes in the abdomen.
Stage IIb
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Description
- Cancer found in the testicle, spermatic cord, or scrotum and in:
- EITHER As many as five lymph abdominal lymph nodes. At least one of the lymph nodes is bigger than 2 cm, but none are bigger than 5 cm.
- OR More than five abdominal lymph nodes. None are bigger than 5 cm.
Tumor markers may be normal or slightly elevated.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by RPLND or chemotherapy.
- Seminoma: Surgery (Orchiectomy), followed by radiation therapy (if the lymph nodes are less than 3 cm in diameter) or chemotherapy (if the lymph nodes are greater than 3 cm in diameter).
Stage IIc
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Description
- Cancer may be found in the testicle, spermatic cord, or scrotum. Cancer has spread to abdominal lymph nodes and they are larger than 5 cm in diameter. All tumor markers are normal or slightly elevated.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by RPLND or chemotherapy.
- Seminoma: Surgery (Orchiectomy), followed by chemotherapy.
Stage IIIa
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Description
- Cancer may be anywhere in the testicle, spermatic cord, or scrotum. Cancer has invaded one or more lymph nodes in the abdomen and may have invaded distant lymph nodes or the lungs. Tumor markers are normal or slightly elevated.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by chemotherapy.
- Seminoma: Surgery (Orchiectomy), followed by chemotherapy.
Stage IIIb
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Description
- Cancer may be anywhere in the testicle, spermatic cord, or scrotum. Cancer may have spread to one or more distant or nearby lymph nodes or to the lungs. One or more tumor markers may be elevated.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by chemotherapy.
- Seminoma: Surgery (Orchiectomy), followed by chemotherapy.
Stage IIIc
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Description
- Cancer may be anywhere in the testicle, spermatic cord, or scrotum. Cancer has spread to other parts of the body.
Treatment
- Nonseminoma: Surgery (Orchiectomy), followed by chemotherapy. Chemoradiation may be used to treat nonseminomas that have spread to the brain.
- Seminoma: Surgery (Orchiectomy), followed by chemotherapy.
