Stages of testicular cancer
The stage of a cancer tells you how big it is and whether it has spread. Doctors also look at the level of certain substances (tumour markers) in your blood. The stage helps your doctor decide which treatment you need.
There are 4 stages of testicular cancer - stage 0 (germ cell neoplasia in situ), 1, 2 and 3.
Staging systems
There are different ways of staging testicular cancer. There is a number staging system and a TNM system and. Doctors usually use the number staging system in the UK.
Number staging
There are 4 main stages - stage 0 to stage 3.
We describe the number staging system below.
TNM staging
Another way to stage testicular cancer is the TNM system. Doctors don't often use this system in the UK to stage testicular cancer. So we don't describe it in detail here.
The TNM staging system stands for Tumour, Node, Metastasis.
- T describes the size of the tumour
- N describes whether there are any cancer cells in the lymph nodes
- M describes whether the cancer has spread to a different part of the body
How do doctors stage testicular cancer?
Your doctor stages your cancer after examining you and looking at test and scan results. They also examine the tissue that the surgeon removes during an operation.
S stage
Doctors also look at the level of certain substances (tumour markers) in your blood. The testicles make these substances. But the cancer cells can increase the amount the testicles make.
This is the S stage:
- S0 means markers are at normal levels
- S1 means markers are slightly raised
- S2 means markers are moderately raised
- S3 means markers are very high
Stage 0 (Germ Cell Neoplasia in situ)
Germ cell neoplasia in situ (GCNIS) means that there are abnormal cells in the testicle. This is sometimes called stage 0.
The cells look abnormal under the microscope. But they are only in the small tubes inside the testicle (the seminiferous tubules). It hasn’t spread into other parts of the testicle. It isn't cancer and doesn’t cause symptoms. But it can become an invasive cancer.
Stage 1
Stage 1 is the earliest stage of testicular cancer. The cancer is only in the testicle and hasn't spread to nearby lymph nodes or other organs.
Stage 1 is split into stage 1A and 1B depending on the size of the tumour. Stage 1S means you have raised levels of markers in your blood after surgery.
Stage 1A means your cancer is still within the testicle and hasn't grown into nearby lymph nodes or blood vessels. Your tumour markers are normal (S0).
Stage 1B means your cancer has grown outside the testicle into nearby structures. But it hasn't spread to any lymph nodes or distant organs. Your tumour markers are normal (S0).
Stage 1S means your cancer might have spread outside the testicle. At least one of your tumour markers levels is raised (S1,S2 or S3).
Stage 2
In stage 2 the cancer cells have spread from the testicle into nearby lymph nodes in your tummy (abdomen) or pelvis.
You might have normal or slightly raised levels of markers in your blood (S0 or S1).
Stage 2 testicular cancer is split into 2A, 2B and 2C. This depends on how many lymph nodes the cancer has spread to and the size of the lymph nodes.
All stage 2 cancers might have grown outside the testicle into nearby structures. But they haven't spread to distant lymph nodes or organs. Your tumour marker levels are normal or slightly raised (S0 or S1).
Stage 2A means the cancer has spread to no more than 5 nearby lymph nodes. These lymph nodes are all 2cm or smaller in size.
Stage 2B means one of the following.
Your cancer has spread:
- to at least one nearby lymph node which is larger than 2cm but no larger than 5cm
- to more than 5 nearby lymph nodes, but these are all smaller than 5cm
- through the outside covering of the lymph node
Stage 2C means your cancer has spread to at least one nearby lymph node which is larger than 5cm.
Stage 3
Stage 3 testicular cancer means that the cancer has spread to lymph nodes or other organs. It is split into 3A, 3B and 3C. This depends on where the cancer has spread to and the levels of the markers in the blood.
All stage 3 cancers might have grown outside the testicle into nearby structures.
Stage 3A means your tumour marker level is normal (S0) or slightly raised (S1). Your cancer has spread to:
- distant lymph nodes, for example near the collarbone
- your lungs
Stage 3B means one of the following. Your cancer has spread to:
- nearby lymph nodes and you have a moderately high tumour marker levels (S2)
- your lungs or distant lymph nodes and you have a moderately high marker level (S2)
Stage 3C means one of the following:
- the same as stage 3B but you have a very high tumour marker level (S3)
- your cancer has spread to another body organ, such as the liver or brain (this used to be called stage 4 testicular cancer) and your tumour markers are any level (S0, S1, S2 or S3)
