Testicular Cancer Staging
The staging of testis cancer refers to how far the cancer has spread. Staging is determined with information from the orchiectomy, tumor markers and imaging studies.
As the testicles form and develop near the kidneys in a fetus, the blood supply, lymphatic drainage and nerves to the testicle originate near the kidney on that side. Therefore, testis cancer has a very predictable pattern of spread. The first place these cancers typically spread is to the lymph nodes around the kidneys, an area called the retroperitoneum. In addition, because testis cancer can secrete tumor markers, blood tests can also determine the spread of disease (patients with very high tumor markers are presumed to have distant metastatic disease).
If the cancer is confined to the testicle it is known as localized cancer. These cancers are also termed stage I cancers. Stage I cancers can be further subdivided into stage IA, IB and IS disease. Stage IA refers to cancers limited to the testicle, without lymphovascular invasion (LVI). LVI is indicative of the aggressiveness of a cancer and the likelihood of spread beyond the testicle. Men with LVI have stage IB cancer. Men with stage IS cancer have their tumor confined to the testicle, but elevated tumor markers after orchiectomy.
If the cancer has spread to the retroperitoneal lymph nodes, it is known as regional spread. Men with regional spread have stage II disease.
If cancer has spread beyond the lymph nodes, it is termed distant metastatic disease. Common sites of metastatic spread include the chest, lungs, brain and lymph nodes of the chest or neck. These men have stage III disease.
Clinical stage refers to how far it appears the cancer has spread based on imaging (like a CT scan). Pathological stage refers to how far cancer has actually spread and is confirmed when tumors are surgically removed, usually after retroperitoneal lymph node dissection.
The National Comprehensive Cancer Network (NCCN) outlines the staging system for testis cancer. The NCCN guidelines for testis cancer can be found here: http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.