Now we come to the testicular cancer staging. It can be divided into 3 stages. Stage 1 includes patients with disease limited to the testis. It may be T1 to T4 depending upon the extent of testicular involvement as we have discussed previously.
In this stage the disease has not spread outside the testis, that is N0 and M0 also the serum tumor markers are normal, that is S0. Rarely, the tumor markers may be elevated in stage 1, when it is called as stage 1S. So stage 1 is the disease which is limited to the testis without any spread elsewhere, with serum tumor markers normal, except in 1 S. Stage 2 includes patients with disease limited to the testis and regional lymph nodes, but there is no spread of the disease to non-regional lymph nodes or any other organs. The markers may be S0 or S1.
As you can see in the figure, stage 2 is the disease limited to the testis and regional or retroperitoneal lymph nodes, without any spread of the disease elsewhere. The markers may be normal or they might be elevated, that is S0 or S1. It may be stage 2A, 2B or 2C depending upon whether the lymph nodes are N1, N2 or N3, respectively, according to the size and number of lymph nodes. And stage 3 includes patients with disease spread to non-regional lymph nodes or other organs, that is M1a or M1b, or those patients with markers highly elevated, that is S2 or S3.
For example, mediastinal lymph node involvement. Or supraclavicular lymph node involvement. Or involvement to inguinal lymph nodes. Stage 3 also includes patients with spread to lungs or pulmonary metastasis. Spread to the liver or spread to the brain or bones, as diagnosed by MRI brain or bone scan.
Also, regional or retroperitoneal lymph node involvement with markers highly elevated, that is in S2 and S3 range also comes under stage 3. So with this, we finish the staging for testicular cancer.
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