Staging and Risk Stratification of Germ-Cell Tumors

Germ cell tumours of the testis are the commonest malignancy in men aged 20-40 years. Considerable therapeutic improvements in management—based on the cancer’s responsiveness to chemotherapy that contains platinum—mean that over 95% of these patients can now expect to be cured.

Staging and Risk Stratification of Germ-Cell Tumors

Stage and Risk Category Primary Tumor Lymph-Node Status Metastasis Status Serum Tumor-Marker Level
IA Involvement of the testis with or without involvement of the tunica albuginea; no involvement of the tunica vaginalis No lymph-node involvement or lympho-vascular invasion No evidence Normal after orchiectomy
IB Involvement of the testis and tunica vaginalis, spermatic cord, or scrotum No lymph-node involvement; lymphovascular
invasion
No evidence Normal after orchiectomy
1S Involvement of the testis with or without involvement of the tunica albuginea, tunica vaginalis, spermatic cord, or scrotum No lymph-node involvement; with or without lymphovascular invasion No evidence Remains elevated and increases after orchiectomy
IIA Same as 1S <5 retroperitoneal lymph nodes, each </=2 cm No evidence Normal or slightly high: LDH <1.5× ULN, B-hCG <5000 mIU/ml, and AFP <1000 ng/ml
IIB Involvement of the testis with or without involvement of the tunica albuginea, tunica vaginalis, spermatic cord, or scrotum >5 retroperitoneal lymph nodes or at least one lymph node >2 cm but </=5 cm No evidence Same as IIA
IIC Involvement of the testis with or without involvement of the tunica albuginea, tunica vaginalis, spermatic cord, or scrotum Retroperitoneal lymph nodes >5 cm No evidence Same as IIA
IIIA Involvement of the testis with or without involvement of the tunica albuginea, tunica vaginalis, spermatic cord, or scrotum Positive or negative lymph nodes Distant lymph nodes or lungs Same as IIA
IIIB Involvement of the testis with or without involvement of the tunica albuginea, tunica vaginalis, spermatic cord, or scrotum Positive or negative lymph nodes Distant lymph nodes or lungs LDH 1.5–10× ULN, B-hCG 5000–50,000 mIU/ml, AFP 1000–10,000 ng/ml, or all of these values
IIIC Involvement of the testis with or without involvement of the tunica albuginea, tunica vaginalis, spermatic cord, or scrotum Positive or negative lymph nodes Nonpulmonary visceral metastases Normal or elevated : LDH >10× ULN, B-hCG >50,000 mIU/ml, or AFP >10,000 ng/ml, or all of these values
Seminoma
Low-risk Any primary site Positive or negative lymph nodes No nonpulmonary visceral metastases Normal AFP, any B-hCG, any LDH
Intermediate- risk Any primary site Positive or negative lymph nodes Nonpulmonary visceral metastases Normal AFP, any B-hCG, any LDH
Nonseminomatous germ-cell tumor
Low-risk Testis or retroperitoneal lymph nodes Positive or negative lymph nodes No nonpulmonary visceral metastases AFP <1000 ng/ml, B-hCG <5000 mIU/ml, and LDH <1.5× ULN
Intermediate-risk Testis or retroperitoneal lymph nodes Positive or negative lymph nodes No nonpulmonary visceral metastases AFP >/=1000 and </=10,000 ng/ml or B-hCG >/=5000 and </=50,000 mIU/ml or LDH >/=1.5× ULN and </=10× ULN
High-risk Testis or retroperitoneal or mediastinal lymph nodes Positive or negative lymph nodes Any site if primary site is anterior mediastinal lymph nodes; nonpulmonary visceral metastases if primary site is testis or retroperitoneal lymph nodes Any of the following levels independently confers high risk: AFP >10,000 ng/ml, B-hCG >50,000 mIU/ml, or LDH >10× ULN

* AFP denotes alpha-fetoprotein, B-hCG beta human chorionic gonadotropin, LDH lactate dehydrogenase, and ULN upper limit of the normal range.
 
 
References:

  1. Hanna NH, Einhorn LH. Testicular cancer–discoveries and updates. N Engl J Med. 2014 Nov 20;371(21):2005-16. [Medline]
  2. Rustin G, Rehman F. State-of-the-art approach in selective curable tumors: germ cell tumors. Ann Oncol. 2008 Sep;19 Suppl 7:vii161-5. [Medline]

Created Mar 04, 2015

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