Primary tumour (T). Except for pTis and pT4, the extent of primary tumour is usually classified after radical orchiectomy, and for this reason, a pathologic stage is assigned. Tx may be used for other categories in the absence of radical orchiectomy
pTx
Primary tumour cannot be assessed
pT0
No evidence of primary tumour (e.g. histologic scar in the testis)
pTis
Intratubular germ cell neoplasia (testicular intraepithelial neoplasia or carcinoma in situ)
pT1
Tumour limited to the testis and epididymis without vascular/lymphatic invasion: tumour may invade into the tunica albuginea but not the tunica vaginalis
pT2
Tumour limited to testis and epididymis with vascular/lymphatic invasion, or tumour extending through the tunica albuginea with involvement of the tunica vaginalis
pT3
Tumour invades the spermatic cord with or without vascular/lymphatic invasion
pT4
Tumour invades scrotum with or without vascular/lymphatic invasion
Regional lymph nodes (N). The following nodes are considered regional: interaortocaval, para–aortic (periaortic), paracaval, preaortic, precaval, retroaortic, retrocaval. Nodes along the spermatic vein are also considered regional. The intrapelvic, external iliac and inguinal nodes are considered regional only after scrotal or inguinal surgery prior to the presentation of the testis tumour. All nodes outside the regional nodes are distant
Clinical (after radiological imaging)
Nx
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1
Metastasis with a lymph node mass 2 cm or less in greatest dimension; or multiple lymph 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; or multiple lymph nodes, any one mass greater 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
Pathologic (after lymph nodes dissection)
pNX
Regional lymph nodes cannot be assessed
pN0
No regional lymph node metastasis
pN1
Metastasis with a lymph node mass 2 cm or less in greatest dimension and less than or equal to 5 nodes positive, none more than 2 cm in greatest dimension
pN2
Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension; or more than 5 nodes positive, none more than 5 cm; or evidence or extranodal extension of tumour
pN3
Metastasis with a lymph node mass more than 5 cm in greatest dimension
Distant metastasis (M)
M0
No distant metastasis
M1
Distant metastasis
M1a
Nonregional nodal or pulmonary metastasis
M1b
Distant metastasis other than to nonregional lymph nodes and lung
The stage grouping given on Table 21.2 incorporates the available post-orchiectomy tumor marker kinetics data.
Group | T | N | M | S (Serum tumour markers) |
|---|---|---|---|---|
Stage 0 | pTIS | N0 | M0 | S0 |
Stage I | pT1–T4 | N0 | M0 | Sx |
Stage IA | pT1 | N0 | M0 | S0 |
Stage IB | pT2-pT4 | N0 < div class='tao-gold-member'>
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