Editing Germ Cell Tumours (section)

== Staging ==

=== TNM (AJCC 8th edition§) ===

==== T stage (primary tumor) ====
* '''pTX''': cannot be assessed
* '''pT0''': no evidence of primary tumour
* '''pTis''': germ cell neoplasia in situ
* '''<span style="color:#ff0000">pT1: tumour limited to testis (including rete testis invastion) without lymphovascular invasion (LVI)</span>'''
** '''<span style="color:#ff0000">For pure seminoma:</span>'''
*** '''<span style="color:#ff0000">pT1a: tumour size < 3 cm</span>'''
*** '''<span style="color:#ff0000">pT1b: tumour size ≥ 3 cm</span>'''
* '''<span style="color:#ff0000">pT2: tumour limited to testis (including rete testis invastion) with LVI or tumour invading hilar soft tissue, epididymis or tunica vaginalis</span>'''
* '''<span style="color:#ff0000">pT3: direct (continuous) spermatic cord soft tissue invasion</span>'''
** LVI of the spermatic cord without soft tissue invasion is not pT3
* '''<span style="color:#ff0000">pT4: direct scrotum invasion</span>'''

==== N Stage (regional lymph node stage) ====
* '''<span style="color:#ff0000">Clinical</span>'''
** cNX: regional lymph nodes cannot be assessed
** cN0: no regional lymph node metastasis
** '''<span style="color:#ff0000">cN1: metastasis with a lymph node mass <u>≤2 cm</u> in greatest dimension OR multiple lymph nodes, each <u>≤2 cm</u> cm in greatest dimension</span>'''
** '''<span style="color:#ff0000">cN2: metastasis with a lymph node mass <u>>2 cm but ≤5</u> cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm</span>'''
** '''<span style="color:#ff0000">cN3: metastasis with a lymph node mass <u>>5 cm</u> in greatest dimension'''</span>
* '''Pathologic'''
** pNX''':''' regional lymph nodes cannot be assessed
** pN0: no regional lymph node metastasis
** '''pN1:''' metastasis with a lymph node mass '''≤2 cm''' in greatest dimension '''AND ≤5 positive nodes''', none >2 cm in greatest dimension
** '''pN2:'''
*** Metastasis with a lymph node mass '''>2 cm but ≤5 cm''' in greatest dimension '''OR'''
*** '''>5 nodes positive,''' none >5 cm in greatest dimension OR
*** '''Extranodal extension of tumour'''
** pN3: metastasis with a lymph node mass '''>5 cm''' in greatest dimension

==== M stage (distant metastasis) ====
* MX: distant metastasis cannot be assessed
* M0: no distant metastasis
* '''M1a: non-regional lymph node (ex: iliac, inguinal, pelvic NOS) or lung metastasis'''
* '''M1b: non-lung visceral metastasis'''

==== S stage (serum markers) ====
* '''SX''': serum tumor markers not available or not performed
* '''S0''': markers within normal limits
* '''S1: LDH < 1.5 x upper limit of normal, hCG < 5,000 mIU/mL and AFP < 1,000 ng/mL'''
* '''S2: LDH 1.5 - 10 x upper limit of normal OR hCG 5,000 - 50,000 mIU/mL OR AFP 1,000 - 10,000 ng/mL'''
* '''S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIU/mL OR AFP > 10,000 ng/mL'''

=== Clinical staging ===
* '''<span style="color:#ff0000">Prognosis of GCT and initial management decisions are determined by clinical stage (CS)'''
* '''<span style="color:#ff0000">Based on (3):'''
*# '''<span style="color:#ff0000">Pathologic stage of the primary tumour (pT stage)'''
*# '''<span style="color:#ff0000">Presence and extent of regional (N stage) and distant metastatic disease (M stage)'''
*# '''<span style="color:#ff0000">Post-orchiectomy serum tumor marker levels (S stage)'''
*#* Serum tumor markers (AFP, hCG, and LDH) should be repeated at appropriate T1/2 time intervals after orchiectomy to determine nadir for staging and risk stratification
*#** For patients with elevated AFP or hCG post-orchiectomy, clinicians should monitor serum tumor markers to establish nadir levels before treatment only if marker nadir levels would influence treatment.
* '''Testicular cancer clinical stage groups'''

{| class="wikitable"
|Stage grouping
|
|
|
|
|-
|Stage 0
|pTis
|N0
|M0
|S0
|-
|Stage I
|pT1-T4
|N0
|M0
|SX
|-
|Stage IA
|pT1
|N0
|M0
|S0
|-
|Stage IB
|pT2 - pT4
|N0
|M0
|S0
|-
|Stage IS
|Any pT/TX
|N0
|M0
|S1-3
|-
|Stage II
|Any pT/TX
|N1-N3
|M0
|SX
|-
| rowspan="2" |Stage IIA
|Any pT/TX
|N1
|M0
|S0
|-
|Any pT/TX
|N1
|M0
|S1
|-
| rowspan="2" |Stage IIB
|Any pT/TX
|N2
|M0
|S0
|-
|Any pT/TX
|N2
|M0
|S1
|-
| rowspan="2" |Stage IIC
|Any pT/TX
|N3
|M0
|S0
|-
|Any pT/TX
|N3
|M0
|S1
|-
|Stage III
|Any pT/TX
|Any N
|M1a
|SX
|-
| rowspan="2" |Stage IIIA
|Any pT/TX
|Any N
|M1a
|S0
|-
|Any pT/TX
|Any N
|M1a
|S1
|-
| rowspan="2" |Stage IIIB
|Any pT/TX
|N1-N3
|M0
|S2
|-
|Any pT/TX
|Any N
|M1a
|S2
|-
| rowspan="3" |Stage IIIC
|Any pT/TX
|N1-N3
|M0
|S3
|-
|Any pT/TX
|Any N
|M1a
|S3
|-
|Any pT/TX
|Any N
|M1b
|Any S
|}

* '''<span style="color:#ff0000">Overview of clinical staging:</span>'''
** '''<span style="color:#ff0000">Clinical stage (CS) I: disease confined to the testis</span>'''
** '''<span style="color:#ff0000">CS II: presence of regional (retroperitoneal) lymph node metastasis</span>'''
** '''<span style="color:#ff0000">CS III: non-regional lymph node and/or visceral metastasis, although post-orchiectomy serum tumour marker levels can upstage patients from CSII to CSIII</span>'''