Testicular cancer - Staging testicular cancer

Testicular cancer

Staging testicular cancer

Doctors put cancer into categories, depending on how far cancer cells have spread in someone's body. This is called staging the cancer. There are two main ways of doing this.

The TNM system

One way of staging cancer is called the TNM system.

Source:
Bosl GJ, Sheinfeld J, Bajorin DF, et al.
Chaper 35: cancer of the testis.
In: DeVita VT, Hellman S, Rosenberg SA (editors). Cancer: principles and practice of oncology. 6th edition. Lippincott Williams and Wilkins, Philadelphia, U.S.A.; 2001.

T stands for tumor. This tells you how big the first lump of cancer cells has got.
N stands for nodes. Cancer cells can start to travel round your body in a network of tiny vessels called your lymph system. For more information, see What is my lymphatic system? If cancer cells reach a

lymph nodes
Lymph nodes (also called glands) are small, bean-shaped lumps that you cannot usually see or easily feel. They are located in various parts of the body, such as the neck, armpit and groin. Lymph nodes filter the lymph fluid and remove unusual things, such as bacteria and cancer cells.

lymph node (a collection of cells that are part of your immune system), the cancer cells can start to grow there and make the lymph node swollen.
M stands for metastasis. This tells you whether cancer cells have spread to another part of your body.

Here's what the different TNM classifications for testicular cancer mean.

	TNM category	What it means
T (tumor)	Tis	The tumor is only in one of your testicles. Cancer cells haven't spread any further. This is called cancer in situ.
	T1	Cancer cells are only found in one of your testicles and the network of tiny tubes just above it (the epididymis).
	T2	Cancer cells are found in one of your testicles and the epididymis. Cancer cells have also spread to nearby blood vessels or lymph vessels.
	T3	Cancer cells have spread to the tube that carries sperm from your testicles to your penis (spermatic cord).
	T4	Cancer cells have spread to your scrotum (the bag of skin that holds your testicle).
N (lymph nodes)	N0	Cancer cells haven't spread to your lymph nodes.
	N1	Cancer cells have spread to some of your lymph nodes, making them get bigger. Stage N1 means that five or fewer lymph nodes have got bigger, and they're all less than 2 centimeters (just under an inch) across.
	N2	More than five of your lymph nodes have got bigger. They're between 2 centimeters and 5 centimeters (between about 1 and 2 inches) across.
	N3	One or more lymph nodes have grown to 5 centimeters (2 inches) across or bigger.
M (metastasis)	M0	Cancer hasn't spread from one of your testicles to another part of your body.
	M1	Cancer cells have spread to the lymph nodes in a part of your body a long way from your testicles. Or cancer cells have spread to your lungs.
	M2	Cancer cells have spread to some of your body's other organs, such as your liver.

Most types of cancer are divided into stages using just these three categories, T, N and M. But if you have testicular cancer, you may have higher-than-normal levels of some chemicals in your blood. These chemicals are sometimes called tumor markers.

You can have a blood test to check for raised levels of these chemicals. The amount of these chemicals in your blood is described using a number, from S0 to S3. The higher the number, the higher the level of these chemicals in your blood.

However, not all men with testicular cancer have high levels of these chemicals. And it's possible to have higher levels of tumor markers in your blood without having testicular cancer.

Stages 1 to 4

Another system of describing how far testicular cancer has spread is called the Royal Marsden Hospital staging system. It uses a number to say how far cancer cells have spread. Stage 1 is the earliest stage of cancer. Stage 4 is the most advanced.

Stage 1

Stage 1 means there's no sign that your cancer has started to spread
Stage 1M means that a blood test has shown you have higher levels of chemicals called tumor markers in your blood. But there's no sign from any other tests that your cancer has spread from the testicle that is affected.

Stage 2

Stage 2A means none of your lymph nodes have swollen to more than 2 centimeters in size (about 1 inch).
Stage 2B means that some of your lymph nodes have swollen to between 2 and 5 centimeters across (1 to 2 inches).
Stage 2C means that some of your lymph nodes have swollen to 5 centimeters (more than 2 inches) across or bigger.

Stage 3

Cancer cells have spread to some of the lymph nodes in your chest or higher up. These could be the lymph nodes in your armpit or above your collarbone.

Stage 4

Cancer cells have spread to other organs in your body. They may have spread to your lungs, liver, your brain or your bones.

In general, the further cancer has spread, the more serious it is. But testicular cancer is easier to treat than most other kinds of cancer. Even men whose cancer has spread have a good chance of recovering.

Source:
Dearnaley DP, Huddart RA, Horwich A.
Managing testicular cancer.
BMJ. 2001; 322: 1583-1588.

² For more information, see What will happen to me?

Sources for the information on this page:

Bosl GJ, Sheinfeld J, Bajorin DF, et al.Chaper 35: cancer of the testis.In: DeVita VT, Hellman S, Rosenberg SA (editors). Cancer: principles and practice of oncology. 6th edition. Lippincott Williams and Wilkins, Philadelphia, U.S.A.; 2001.

Dearnaley DP, Huddart RA, Horwich A.Managing testicular cancer.BMJ. 2001; 322: 1583-1588.

This information was last updated on May 14, 2008

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

The information on ConsumerReportsHealth.org should not be viewed as a substitute for a consultation with a medical or health professional. The information is meant to enhance communication with your doctor, not replace it. Consumers Union can not be liable for any loss, injury, or other damages related to your use of this information.

Your use of this information is subject to our User Agreement available at www.ConsumerReportsHealth.org.