Key Points for This Section

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. There are three ways that cancer spreads in the body. The following stages are used for testicular cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III

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, 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.



• Lymphangiography: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.



• Abdominal lymph node dissection: A procedure to examine lymph nodes in the abdomen. Lymph nodes are removed and a pathologist checks them for cancer cells. 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.



• Radical inguinal orchiectomy and biopsy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy, because if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.)



• 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 or 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 (β-hCG).
  • Lactate dehydrogenase (LDH).
  Tumor marker levels are measured again, after radical 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.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for testicular cancer:

Stage 0 (Carcinoma in Situ)

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 carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.

• In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.



• In stage IB, cancer:
  • is in the testicle and the epididymis and has spread to the blood or lymph vessels in the testicle; or
  • has spread to the outer layer of the membrane surrounding the testicle; or
  • is in the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle.
  All tumor marker levels are normal.



• In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
  • all tumor marker levels are slightly above normal; or
  • one or more tumor marker levels are moderately above normal or high.

Enlarge

Pea, peanut, walnut, and lime show tumor sizes.

Stage II

Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.

• In stage IIA, cancer:
  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.
  All tumor marker levels are normal or slightly above normal.



• In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:
  • has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
  • has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
  All tumor markers levels are normal or slightly above normal.



• In stage IIC, cancer:
  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • has spread to a lymph node in the abdomen that is larger than 5 centimeters.
  All tumor marker levels are normal or slightly above normal.

Stage III

Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.

• In stage IIIA, cancer:
  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • may have spread to one or more lymph nodes in the abdomen; and
  • has spread to distant lymph nodes or to the lungs.
  The level of one or more tumor markers may range from normal to slightly above normal.



• In stage IIIB, cancer:
  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • may have spread to one or more nearby or distant lymph nodes or to the lungs.
  The level of one or more tumor markers may range from normal to high.



• In stage IIIC, cancer:
  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • may have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body.
  The level of one or more tumor markers may range from normal to very high.

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