How Testicular Cancer is Staged

What is cancer staging?

Stage refers to the degree of spread of cancer. Each cancer type has its own specific staging. For example, lymphoma has a completely different staging system compared to breast cancer, even though each one utilizes a numerical system of staging. Stages I, II, III and IV are commonly used for most cancer types (stage is written using roman numerals). Stage typically depends on two main things: the size of the primary tumor and its level of invasion and spread (i.e., is it invading local tissues?

Has it spread to other organs?).


Why does stage matter?

Stage is one of the most important factors when it comes to determining treatment options and prognosis. Whether a cancer is curable oftentimes depends on stage. Early stages of cancer oftentimes require less treatment whereas advanced stages may require more extensive treatment. For example, an early stage cancer may be cured by surgery alone. An advanced stage cancer may not only require surgery but may also require chemotherapy, radiation or other modalities to attempt to achieve cure. Various signs and symptoms may be seen depending on the stage of the cancer.


How is testicular cancer staged?

Most testicular cancers use the same staging system. However, there are multiple cancer types which can develop in the testicles, which can affect staging. Information on the different types may be found here.

Although other staging systems exist, the most common is the TNM system.

T refers to tumor, N to nodes and M to metastasis. In many other cancer staging systems T refers to the tumor size itself. In testicular cancer, it refers to tumor invasion. T is followed by a number 1-4 depending on whether it is limited to the testicle (T1) or progressively invasive to the point where the scrotum is invaded (T4).

N refers to the size of involved regional lymph nodes and ranges from N0-N3. N0: no known nodes contain cancer. N1: lymph nodes smaller than 2 cm. N2: lymph nodes greater than 2 cm but smaller than 5 cm. N3: lymph nodes greater than 5 cm.

M refers to whether the cancer has metastasized. M0 means it has not metastasized and M1 means it has. M gets even more specific by using M1a to mean metastasis to the lungs or nonregional nodes (the most common sites for testicular cancer to spread), whereas M1b means it has spread to any other location.

Testicular cancer staging has a unique staging element in that it incorporates tumor markers into the system, but only for stage I disease. Tumor markers are checked by drawing blood after the cancerous testicle has already been removed. For tumor markers S is used. S0 means the tumor markers are normal following surgery. S1, S2 and S3 mean the tumor markers are increasingly high following surgery. Persistently elevated tumor markers following surgery invariably indicate residual cancer cells within the body somewhere, although they are not apparent on scans or from surgery.

The reason for that is the fact that microscopic cells are pretty much impossible to find amongst the trillions of cells that make up the human body. Again, this only applies to stage I. The reason for this is that in stages II and III it is already known that the cancer has spread to nodes or other organs/tissues so tumor markers will, of course, remain elevated after removing the testicle because cancer is still present in these known locations. The main purpose behind the S staging is to determine whether someone needs additional treatment following surgical removal of the tesical such as chemotherapy or radiation.

How does the TNM system relate to the actual roman numeric stages, which were mentioned earlier? First of all, testicular cancer is one of the few cancers that does not have a stage IV. The stages run from I-III, which are figured using the TNM system. You have to figure out the T, N, M and S (if S is applicable) and line it up accordingly to the following table:

Stage Tumor (T) Nodes (N)Metastasis (M)

Markers (S)

ISAny TN0M0S1-3
IIAAny TN1M0S0-1
IIBAny TN2M0S0-1
IICAny TN3M0S0-1
IIIAAny TAny NM1aS0-1
 Any TAny NM1aS2
 Any TAny NM1aS3
 Any TAny NM1bAny S

Feeling confused?

This system can appear very confusing and complicated. Here is a simplified summary of the stages:

  • Stage I: No spread beyond the region of the testicle.

  • Stage II: Spread to regional nodes (typically a group of nodes behind the bowel in a location known as the retroperitoneum).

  • Stage III: Spread distantly to nonregional nodes or any other places like the lungs or liver.

Want to know more? Check here for the basics of testicular cancer and also for the causes of testicular cancer.

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