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 (blood tests) 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, then it is known as Stage I or localized cancer. Stage I cancers have an excellent cure rate: Approximately 99% of men with Stage I disease will be cured, and can be further subdivided into stage IA, IB and IS disease — which refer to the risk of recurrence. 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 IA and IB disease are often followed closely with surveillance, although chemotherapy or retroperitoneal lymph node dissection (RPLND) are options to minimize the risk of recurrence. Men with stage IS cancer have their tumor confined to the testicle, but elevated tumor markers after orchiectomy. Men with Stage IS disease require chemotherapy for cure.
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 (such as a CT scan). Pathological stage refers to how far cancer has actually spread and is confirmed when tumors are surgically removed, usually after RPLND.