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