Stages of Testicular Cancer

After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body.

The process used to find out if cancer has spread within the testicles or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the abdomen. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Abdominal lymph node dissection: A surgical procedure in which lymph nodes in the abdomen are removed and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy.
• Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumor markers are used in staging testicular cancer:
  • Alpha-fetoprotein (AFP)
  • Beta-human chorionic gonadotropin (beta-hCG).
  • Lactate dehydrogenase (LDH).
  Tumor marker levels are measured again, after inguinal orchiectomy and biopsy, in order to determine the stage of the cancer. This helps to show if all of the cancer has been removed or if more treatment is needed. Tumor marker levels are also measured during follow-up as a way of checking if the cancer has come back.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if testicular cancer spreads to the lung, the cancer cells in the lung are actually testicular cancer cells. The disease is metastatic testicular cancer, not lung cancer.

The following stages are used for testicular cancer:

Stage 0

In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called germ cell neoplasia in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA, IB, and IS.

• In stage IA, cancer is found in the testicle, including the rete testis, but has not spread to the blood vessels or lymph vessels in the testicle.

  All tumor marker levels are normal.

• In stage IB, cancer:
  • is found in the testicle, including the rete testis, and has spread to the blood vessels or lymph vessels in the testicle; or
  • has spread into the hilar soft tissue (tissue made of fibers and fat with blood vessels and lymph vessels), the epididymis, or the outer membranes around the testicle; or
  • has spread to the spermatic cord; or
  • has spread to the scrotum.

  All tumor marker levels are normal.

• In stage IS, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum.

  Tumor marker levels range from slightly above normal to high.

Stage II

Stage II is divided into stages IIA, IIB, and IIC.

• In stage IIA, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer has spread to 1 to 5 nearby lymph nodes and the lymph nodes are 2 centimeters or smaller.

  All tumor marker levels are normal or slightly above normal.

• In stage IIB, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer has spread to:
  • 1 nearby lymph node and the lymph node is larger than 2 centimeters but not larger than 5 centimeters; or
  • more than 5 nearby lymph nodes and the lymph nodes are not larger than 5 centimeters; or
  • a nearby lymph node and the cancer has spread outside the lymph node.

  All tumor marker levels are normal or slightly above normal.

• In stage IIC, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer has spread to a nearby lymph node and the lymph node is larger than 5 centimeters.

  All tumor marker levels are normal or slightly above normal.

Stage III

Stage III is divided into stages IIIA, IIIB, and IIIC.

• In stage IIIA, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer may have spread to one or more nearby lymph nodes. Cancer has spread to distant lymph nodes or to the lungs.

  All tumor marker levels are normal or slightly above normal.

• In stage IIIB, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer has spread:
  • to one or more nearby lymph nodes and has not spread to other parts of the body; or
  • to one or more nearby lymph nodes. Cancer has spread to distant lymph nodes or to the lungs.

  The level of one or more tumor markers is moderately above normal.

• In stage IIIC, cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer has spread:
  • to one or more nearby lymph nodes and has not spread to other parts of the body; or
  • to one or more nearby lymph nodes. Cancer has spread to distant lymph nodes or to the lungs.

  The level of one or more tumor markers is high.

  or

  Cancer is found anywhere in the testicle and may have spread into the spermatic cord or scrotum. Cancer has not spread to distant lymph nodes or the lung, but has spread to other parts of the body, such as the liver or bone.

  Tumor marker levels may range from normal to high.

Testicular cancer can recur (come back) after it has been treated.

The cancer may come back many years after the initial cancer, in the other testicle or in other parts of the body.