Testicular Cancer Staging and Grading
There are two terms that patients should understand regarding the diagnosis and treatment of their cancer: staging and grading. These terms are used by the doctor when it comes to planning treatment, prescribing medications, deciding on surgical treatments or even estimating the likely long-term outcome or course of the disease.
Staging is a way to describe the extent or severity of an individual’s cancer. As the tumor develops, it can invade nearby organs and tissues, or cells can break off and enter the bloodstream or lymphatic system. The cancer then spreads (also called metastasizing) to form new tumors in other organs.
Doctors determine a cancer’s “clinical stage” by using a combination of physical examinations, imaging (such as CT or MRI scans), laboratory tests, biopsies, pathology reports and even physical symptoms a patient describes. If the tumor is removed, microscopic examination by the pathologist often reveals a more complete “pathologic stage”. Although competing staging systems still exist for some types of cancer, the universally-accepted staging system is that of the “TNM Classification”. The “T” describes the size of the tumor and whether it has invaded nearby tissue, the “N” describes regional lymph nodes that are involved, and the “M” describes distant metastasis (spread of cancer from one body part to another).
Cancer grading (also called tumor grading) is a system used to classify the aggressiveness of cancer cells in terms of how abnormal they look under a microscope and how quickly the tumor is likely to grow and spread. This information can be obtained from a small sample (biopsy) of the tumor. However, as in staging, the information can be more accurate by microscopic examination of the entire tumor following complete removal. For most cancers, grades are described on a scale from 1 to 3 (or 4) from least to most aggressive. However, grading systems can be different for each type of cancer.
Testicular Cancer Staging:
The “T” stage with testicular tumors is determined by microscopic analysis of the removed testicle by the pathologist (depicted with a lower case “p” as a prefix as in “pT1”.
pTis: Intratubular germ cell neoplasia (carcinoma in situ)
pT1: Tumor limited to testis and epididymis without vascular/lymphatic invasion; tumor may invade tunica albuginea but not tunica vaginalis.
pT2: Tumor limited to testis and epididymis with vascular/lymphatic invasion, or tumor extending through tunica albuginea with involvement of tunica vaginalis.
pT3: Tumor invades spermatic cord with or without vascular/lymphatic invasion.
pT4: Tumor invades scrotum with or without vascular/ lymphatic invasion.
The “N” stage with testicular tumors is determined by CT scan of the abdomen. Testicular cancer usually spreads first to the lymph nodes in the back of the abdomen.
N0: No regional lymph node metastasis
N1: Metastasis with a lymph node mass 2 cm or less in greatest dimension and 5 or fewer positive nodes, none more than 2 cm in greatest dimension
N2: Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension
N3: Metastasis with a lymph node mass more than 5 cm in greatest dimension