Radiation Oncology/Testis/Staging

AJCC 7th Edition (2009) Primary Tumor: T1 - limited to testis and epididymis without vascular/lymphatic invasion; may invade into the tunica albuginea but not the tunica vaginalis T2 - limited to testis and epididymis with vascular/lymphatic invasion; or tumor involving the tunica vaginalis T3 - invades the spermatic cord T4 - invades the scrotum Regional Lymph Nodes: Regional nodes: para-aortic, interaortocaval, para/pre/retrocaval, pre/retroaortic LN Intrapelvic, external iliac, and inguinal LN are considered regional only after scrotal or inguinal surgery. Clinical: N1 - lymph node mass 2 cm or less in greatest dimension; or multiple lymph nodes, none more than 2 cm in greatest dimension N2 - lymph node mass 2 - 5 cm; or multiple lymph nodes, any one mass 2 - 5 cm N3 - lymph node mass > 5 cm Pathologic: N1 - lymph node mass 2 cm or less in greatest dimension, and <= 5 nodes positive, none more than 2 cm in greatest dimension N2 - lymph node mass 2 - 5 cm; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension N3 - lymph node mass > 5 cm Distant Metastases: M1a - non-regional nodal or pulmonary mets M1b - other distant mets Serum tumor markers (S): Note: (from the AJCC Staging Manual, 7th Edition) "Serum tumor markers should be measured prior to orchiectomy, but levels after orchiectomy are used for assignment of S category .... Stage grouping classification of Stage IS requires persistent elevation of serum tumor markers following orchiectomy." (* corrected in erratum) S0 - serum markers within normal limits S1 - LDH < 1.5 * upper limit of normal, AND hCG < 5000 mIu/mL, AND AFP < 1000 ng/mL S2 - LDH 1.5 - 10 * normal range, OR hCG 5000-50,000, OR AFP 1000-10,000 S3 - LDH > 10 * normal range, OR hCG >50,000, OR AFP > 10,000 Stage Grouping: IA - T1 N0 M0 S0 IB - T2-4 N0 M0 S0 IS - Any T N0 M0 S1-3 IIA - Any T N1 M0 S0-1 IIB - Any T N2 M0 S0-1 IIC - Any T N3 M0 S0-1 IIIA - Any T Any N M1a S0-1 IIIB - S2 and either N1-3 or M1a IIIC - S3 and either N1-3 or M1a; or M1b *Erratum: AJCC 5th reprint corrected pages Older staging systems AJCC 6th Edition (2002) No changes compared to 7th Edition