Staging of testicular cancer

There are several staging systems for testicular cancer.

A staging system commonly used in the UK is the TNM system:

• T refers to the size of the tumour.  
• N refers to whether lymph nodes are affected.
• M refers to whether cancer has spread to other parts of the body (metastases).

Tumour size (T)

• TIS (testicular carcinoma in situ) Cancer cells are in the tubules of the testes but haven’t moved into the surrounding tissue of the testicle.
• T1 The tumour is only in the testicle and epididymis.
• T2 The tumour has started to grow into blood vessels or lymph vessels.
• T3 The tumour has grown as far as the spermatic cord (and possibly also the blood vessels or lymph vessels).
• T4 The tumour has grown into the scrotum.

Lymph nodes (N)

The N refers to whether the cancer cells have spread into the lymph nodes nearby and, if so, what size of lymph node is affected (some are larger than others). If lymph nodes are affected they’re said to be positive.

• N0 The lymph nodes have no cancer cells.
• N1 The lymph nodes affected are less than 2cm wide.
• N2 At least one affected lymph node is 2–5cm wide.
• N3 At least one affected lymph node is more than 5cm wide.

Metastases (M)

Metastases refer to how far the cancer has spread.

• M0 The cancer hasn’t spread to other organs.
• M1a The cancer has spread to the lungs or to distant lymph nodes (those furthest away from the testicles such as near the collarbone).
• M1b Other organs are affected – for example, the brain or the liver.