Radiation Oncology/Testis/Staging

AJCC 7th Edition (2009) Primary Tumor:
 * T1 - limited to testis and epididymis without vascular/lymphatic invasion; may invade into the tunica albuginea but not the tunica vaginalis
 * T2 - limited to testis and epididymis with vascular/lymphatic invasion; or tumor involving the tunica vaginalis
 * T3 - invades the spermatic cord
 * T4 - invades the scrotum

Regional Lymph Nodes:
 * Regional nodes: para-aortic, interaortocaval, para/pre/retrocaval, pre/retroaortic LN
 * Intrapelvic, external iliac, and inguinal LN are considered regional only after scrotal or inguinal surgery.
 * Clinical:


 * N1 - lymph node mass 2 cm or less in greatest dimension; or multiple lymph nodes, none more than 2 cm in greatest dimension
 * N2 - lymph node mass 2 - 5 cm; or multiple lymph nodes, any one mass 2 - 5 cm
 * N3 - lymph node mass > 5 cm
 * Pathologic:


 * N1 - lymph node mass 2 cm or less in greatest dimension, and <= 5 nodes positive, none more than 2 cm in greatest dimension
 * N2 - lymph node mass 2 - 5 cm; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension
 * N3 - lymph node mass > 5 cm

Distant Metastases:
 * M1a - non-regional nodal or pulmonary mets
 * M1b - other distant mets

Serum tumor markers (S):
 * ''Note: (from the AJCC Staging Manual, 7th Edition) "Serum tumor markers should be measured prior to orchiectomy, but levels after orchiectomy are used for assignment of S category .... Stage grouping classification of Stage IS requires persistent elevation of serum tumor markers following orchiectomy." (* corrected in erratum)
 * S0 - serum markers within normal limits
 * S1 - LDH < 1.5 * upper limit of normal, AND hCG < 5000 mIu/mL, AND AFP < 1000 ng/mL
 * S2 - LDH 1.5 - 10 * normal range, OR hCG 5000-50,000, OR AFP 1000-10,000
 * S3 - LDH > 10 * normal range, OR hCG >50,000, OR AFP > 10,000

Stage Grouping:
 * IA - T1 N0 M0 S0
 * IB - T2-4 N0 M0 S0
 * IS - Any T N0 M0 S1-3
 * IIA - Any T N1 M0 S0-1
 * IIB - Any T N2 M0 S0-1
 * IIC - Any T N3 M0 S0-1
 * IIIA - Any T Any N M1a S0-1
 * IIIB - S2 and either N1-3 or M1a
 * IIIC - S3 and either N1-3 or M1a; or M1b


 * Erratum: AJCC 5th reprint corrected pages

Older staging systems
AJCC 6th Edition (2002) No changes compared to 7th Edition