Germ Cell Tumours: Difference between revisions

Line 316:

== Staging ==

* '''TNM~~''' '''~~(AJCC 8th edition§)~~'''~~

=== TNM (AJCC 8th edition§) ===

** '''T stage (primary tumor)~~'''~~

*** '''pTX''': cannot be assessed

==== T stage (primary tumor) ====

*** '''pT0''': no evidence of primary tumour

* '''pTX''': cannot be assessed

*** '''pTis''': germ cell neoplasia in situ

* '''pT0''': no evidence of primary tumour

*** '''pT1: tumour limited to testis (including rete testis invastion) without lymphyovascular invasion (LVI)'''

* '''pTis''': germ cell neoplasia in situ

**** '''For pure seminoma:'''

* '''pT1: tumour limited to testis (including rete testis invastion) without lymphyovascular invasion (LVI)'''

***** '''pT1a: tumour size < 3 cm'''

** '''For pure seminoma:'''

***** '''pT1b: tumour size ≥ 3 cm'''

*** '''pT1a: tumour size < 3 cm'''

*** '''pT2: tumour limited to testis (including rete testis invastion) with LVI or tumour invading hilar soft tissue, epididymis or tunica vaginalis'''

*** '''pT1b: tumour size ≥ 3 cm'''

*** '''pT3: direct (continuous) spermatic cord soft tissue invasion'''

* '''pT2: tumour limited to testis (including rete testis invastion) with LVI or tumour invading hilar soft tissue, epididymis or tunica vaginalis'''

**** LVI of the spermatic cord without soft tissue invasion is not pT3

* '''pT3: direct (continuous) spermatic cord soft tissue invasion'''

*** '''pT4: direct scrotum invasion'''

** LVI of the spermatic cord without soft tissue invasion is not pT3

** '''N Stage (regional lymph node stage)~~'''~~

* '''pT4: direct scrotum invasion'''

*** '''Clinical'''

**** cNX: regional lymph nodes cannot be assessed

==== N Stage (regional lymph node stage) ====

**** cN0: no regional lymph node metastasis

* '''Clinical'''

**** '''cN1: metastasis with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, each ≤2 cm cm in greatest dimension'''

** cNX: regional lymph nodes cannot be assessed

**** '''cN2: metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm'''

** cN0: no regional lymph node metastasis

**** '''cN3: metastasis with a lymph node mass >5 cm in greatest dimension'''

** '''cN1: metastasis with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, each ≤2 cm cm in greatest dimension'''

*** '''Pathologic'''

** '''cN2: metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm'''

**** pNX''':''' regional lymph nodes cannot be assessed

** '''cN3: metastasis with a lymph node mass >5 cm in greatest dimension'''

**** pN0: no regional lymph node metastasis

* '''Pathologic'''

**** '''pN1:''' metastasis with a lymph node mass '''≤2 cm''' in greatest dimension '''AND ≤5 positive nodes''', none >2 cm in greatest dimension

** pNX''':''' regional lymph nodes cannot be assessed

**** '''pN2:'''

** pN0: no regional lymph node metastasis

***** Metastasis with a lymph node mass '''>2 cm but ≤5 cm''' in greatest dimension '''OR'''

** '''pN1:''' metastasis with a lymph node mass '''≤2 cm''' in greatest dimension '''AND ≤5 positive nodes''', none >2 cm in greatest dimension

***** '''>5 nodes positive,''' none >5 cm in greatest dimension OR

** '''pN2:'''

***** '''Extranodal extension of tumour'''

*** Metastasis with a lymph node mass '''>2 cm but ≤5 cm''' in greatest dimension '''OR'''

**** pN3: metastasis with a lymph node mass '''>5 cm''' in greatest dimension

*** '''>5 nodes positive,''' none >5 cm in greatest dimension OR

** '''Distant metastasis~~'''~~

*** '''Extranodal extension of tumour'''

*** MX: distant metastasis cannot be assessed

** pN3: metastasis with a lymph node mass '''>5 cm''' in greatest dimension

*** M0: no distant metastasis

*** '''M1a: non-regional lymph node (ex: iliac, inguinal, pelvic NOS) or lung metastasis'''

==== M stage (distant metastasis) ====

*** '''M1b: non-lung visceral metastasis'''

* MX: distant metastasis cannot be assessed

** '''Serum markers (S)~~'''~~

* M0: no distant metastasis

*** '''SX''': serum tumor markers not available or not performed

* '''M1a: non-regional lymph node (ex: iliac, inguinal, pelvic NOS) or lung metastasis'''

*** '''S0''': markers within normal limits

* '''M1b: non-lung visceral metastasis'''

*** '''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'''

==== S stage (serum markers) ====

*** '''S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIU/mL OR AFP > 10,000 ng/mL'''

* '''SX''': serum tumor markers not available or not performed

* '''Clinical staging~~'''~~

* '''S0''': markers within normal limits

** '''Prognosis of GCT and initial management decisions are determined by clinical stage (CS)'''

* '''S1: LDH < 1.5 x upper limit of normal, hCG < 5,000 mIU/mL and AFP < 1,000 ng/mL'''

** '''Based on (3):'''

* '''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'''

**# '''Pathologic stage of the primary tumour (pT stage)'''

* '''S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIU/mL OR AFP > 10,000 ng/mL'''

**# '''Presence and extent of regional (N stage) and distant metastatic disease (M stage)'''

**# '''Post-orchiectomy serum tumor marker levels (S stage)'''

=== Clinical staging ===

**#* 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

* '''Prognosis of GCT and initial management decisions are determined by clinical stage (CS)'''

**#** 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.

* '''Based on (3):'''

** '''Testicular cancer clinical stage groups'''

*# '''Pathologic stage of the primary tumour (pT stage)'''

*# '''Presence and extent of regional (N stage) and distant metastatic disease (M stage)'''

*# '''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"

@@ Line 316: / Line 316: @@
 == Staging ==
-* '''<span style="color:#ff0000">TNM</span>''' '''(AJCC 8th edition§)'''
+=== <span style="color:#ff0000">TNM</span> (AJCC 8th edition§) ===
-** '''<span style="color:#ff0000">T stage (primary tumor)</span>'''
-*** '''pTX''': cannot be assessed
+==== <span style="color:#ff0000">T stage (primary tumor)</span> ====
-*** '''pT0''': no evidence of primary tumour
+* '''pTX''': cannot be assessed
-*** '''pTis''': germ cell neoplasia in situ
+* '''pT0''': no evidence of primary tumour
-*** '''<span style="color:#ff0000">pT1: tumour limited to testis (including rete testis invastion) without lymphyovascular invasion (LVI)</span>'''
+* '''pTis''': germ cell neoplasia in situ
-**** '''<span style="color:#ff0000">For pure seminoma:</span>'''
+* '''<span style="color:#ff0000">pT1: tumour limited to testis (including rete testis invastion) without lymphyovascular invasion (LVI)</span>'''
-***** '''<span style="color:#ff0000">pT1a: tumour size < 3 cm</span>'''
+** '''<span style="color:#ff0000">For pure seminoma:</span>'''
-***** '''<span style="color:#ff0000">pT1b: tumour size ≥ 3 cm</span>'''
+*** '''<span style="color:#ff0000">pT1a: 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">pT1b: tumour size ≥ 3 cm</span>'''
-*** '''<span style="color:#ff0000">pT3: direct (continuous) spermatic cord soft tissue invasion</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>'''
-**** LVI of the spermatic cord without soft tissue invasion is not pT3
+* '''<span style="color:#ff0000">pT3: direct (continuous) spermatic cord soft tissue invasion</span>'''
-*** '''<span style="color:#ff0000">pT4: direct scrotum invasion</span>'''
+** LVI of the spermatic cord without soft tissue invasion is not pT3
-** '''<span style="color:#ff0000">N Stage (regional lymph node stage)</span>'''
+* '''<span style="color:#ff0000">pT4: direct scrotum invasion</span>'''
-*** '''<span style="color:#ff0000">Clinical</span>'''
-**** cNX: regional lymph nodes cannot be assessed
+==== <span style="color:#ff0000">N Stage (regional lymph node stage)</span> ====
-**** cN0: no regional lymph node metastasis
+* '''<span style="color:#ff0000">Clinical</span>'''
-**** '''<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>'''
+** cNX: regional lymph nodes cannot be assessed
-**** '''<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>'''
+** cN0: no regional lymph node metastasis
-**** '''<span style="color:#ff0000">cN3: metastasis with a lymph node mass <u>>5 cm</u> in greatest dimension'''</span>
+** '''<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>'''
-*** '''Pathologic'''
+** '''<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>'''
-**** pNX''':''' regional lymph nodes cannot be assessed
+** '''<span style="color:#ff0000">cN3: metastasis with a lymph node mass <u>>5 cm</u> in greatest dimension'''</span>
-**** pN0: no regional lymph node metastasis
+* '''Pathologic'''
-**** '''pN1:''' metastasis with a lymph node mass '''≤2 cm''' in greatest dimension '''AND ≤5 positive nodes''', none >2 cm in greatest dimension
+** pNX''':''' regional lymph nodes cannot be assessed
-**** '''pN2:'''
+** pN0: no regional lymph node metastasis
-***** Metastasis with a lymph node mass '''>2 cm but ≤5 cm''' in greatest dimension '''OR'''
+** '''pN1:''' metastasis with a lymph node mass '''≤2 cm''' in greatest dimension '''AND ≤5 positive nodes''', none >2 cm in greatest dimension
-***** '''>5 nodes positive,''' none >5 cm in greatest dimension OR
+** '''pN2:'''
-***** '''Extranodal extension of tumour'''
+*** Metastasis with a lymph node mass '''>2 cm but ≤5 cm''' in greatest dimension '''OR'''
-**** pN3: metastasis with a lymph node mass '''>5 cm''' in greatest dimension
+*** '''>5 nodes positive,''' none >5 cm in greatest dimension OR
-** '''Distant metastasis'''
+*** '''Extranodal extension of tumour'''
-*** MX: distant metastasis cannot be assessed
+** pN3: metastasis with a lymph node mass '''>5 cm''' in greatest dimension
-*** M0: no distant metastasis
-*** '''M1a: non-regional lymph node (ex: iliac, inguinal, pelvic NOS) or lung metastasis'''
+==== M stage (distant metastasis) ====
-*** '''M1b: non-lung visceral metastasis'''
+* MX: distant metastasis cannot be assessed
-** '''Serum markers (S)'''
+* M0: no distant metastasis
-*** '''SX''': serum tumor markers not available or not performed
+* '''M1a: non-regional lymph node (ex: iliac, inguinal, pelvic NOS) or lung metastasis'''
-*** '''S0''': markers within normal limits
+* '''M1b: non-lung visceral metastasis'''
-*** '''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'''
+==== S stage (serum markers) ====
-*** '''S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIU/mL OR AFP > 10,000 ng/mL'''
+* '''SX''': serum tumor markers not available or not performed
-* '''<span style="color:#ff0000">Clinical staging'''
+* '''S0''': markers within normal limits
-** '''<span style="color:#ff0000">Prognosis of GCT and initial management decisions are determined by clinical stage (CS)'''
+* '''S1: LDH < 1.5 x upper limit of normal, hCG < 5,000 mIU/mL and AFP < 1,000 ng/mL'''
-** '''<span style="color:#ff0000">Based on (3):'''
+* '''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'''
-**# '''<span style="color:#ff0000">Pathologic stage of the primary tumour (pT stage)'''
+* '''S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIU/mL OR AFP > 10,000 ng/mL'''
-**# '''<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)'''
+=== <span style="color:#ff0000">Clinical staging ===
-**#* 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
+* '''<span style="color:#ff0000">Prognosis of GCT and initial management decisions are determined by clinical stage (CS)'''
-**#** 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.
+* '''<span style="color:#ff0000">Based on (3):'''
-** '''Testicular cancer clinical stage groups'''
+*# '''<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"