Pathology & Staging
Pathology is the precise study and diagnosis of disease. A clinical pathologist will look at the cells from your orchiectomy or biopsy to determine what stage of testicular cancer you have, if any. The pathologist’s report will determine the treatment you will receive.
Staging
Staging is the process of finding out how far the cancer has spread, and this process is very important because your treatment options and prognosis depend on the "stage" of your cancer. In this video, Dr. Joseph Shirk explains stages 0-3c, and why there is not a stage 4 in testicular cancer. You can also read about the stages below.
Examinations and Tests for Staging Testicular Cancer
Computed Tomography Scan (CT scan): This test uses a rotating x-ray beam to create a series of pictures of the body from many angles. A computer processes the information provided by the scan and produces a detailed cross-sectional image of the selected part of the body. To highlight details on a CT scan, a dye may be injected into a vein. The CT scan is especially valuable in identifying the spread of tumors to the lymph nodes.
Lymphangiography: In this procedure, a special dye is injected into a lymph vessel which is carried into the lymph nodes. Enlarged lymph nodes could be a sign of that cancer has spread and your body is fighting an infection. During lymphangiography, a special viewing monitor displays x-ray images or the lymph node system which doctors can study to detect signs that the cancer has metastasized. CT scans have replaced lymphangiography in staging most cases of testicular cancer.
Magnetic Resonance Imaging (MRI): This technique uses magnetic fields and radio waves instead of x-rays to create images of certain areas of the body. These images can show enlarged lymph nodes and abnormal nodules of certain organs that may indicate the spread of cancer from the testicles. An MRI is not often done for testicular cancer staging, since a CT scan provides the same results at a lower cost.
Other Tests: Chest x-rays, bone scans and other tests may be performed if metastasis is suspected. Also blood tests for proteins AFP, HCG and LDH will be performed.
Stage 0
In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called germ cell neoplasia in situ.
Stage I
In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.
In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.
In stage IB, cancer:
is in the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle; or
has spread to the outer layer of the membrane surrounding the testicle; or
is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle.
All tumor marker levels are normal.
In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
all tumor marker levels are slightly above normal to high.
Stage II
Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.
In stage IIA, cancer:
is anywhere within the testicle, spermatic cord, or scrotum; and
has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.
All tumor marker levels are normal or slightly above normal.
In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:
has spread to up to 5 nearby lymph nodes; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
All tumor marker levels are normal or slightly above normal.
In stage IIC, cancer:
is anywhere within the testicle, spermatic cord, or scrotum; and
has spread to a lymph node in the abdomen that is larger than 5 centimeters.
All tumor marker levels are normal or slightly above normal.
Stage III
Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.
In stage IIIA, cancer:
is anywhere within the testicle, spermatic cord, or scrotum; and
may have spread to one or more nearby lymph nodes; and
has spread to distant lymph nodes or to the lungs.
Tumor marker levels may range from normal to slightly above normal.
In stage IIIB, cancer:
is anywhere within the testicle, spermatic cord, or scrotum; and
may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.
The level of one or more tumor markers is moderately above normal.
In stage IIIC, cancer:
is anywhere within the testicle, spermatic cord, or scrotum; and
may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.
The level of one or more tumor markers is high.
or
Cancer:
is anywhere within the testicle, spermatic cord, or scrotum; and
may have spread to one or more lymph nodes in the abdomen; and
has not spread to distant lymph nodes or the lungs but has spread to other parts of the body.
Tumor marker levels may range from normal to high.
If you have any possible signs & symptoms of testicular cancer, seek medical attention immediately.
Testicular Cancer can recur (come back) after treatment. The cancer may come back many years after the initial diagnosis, either in the other testicle or in another part of the body.