{"id":2352,"date":"2015-01-30T14:59:38","date_gmt":"2015-01-30T14:59:38","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/urogct\/"},"modified":"2026-04-06T19:38:21","modified_gmt":"2026-04-06T19:38:21","slug":"urogct","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/urogct\/","title":{"rendered":"Staging and Risk Stratification of Germ-Cell Tumors"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Germ cell tumours of the testis are the commonest malignancy in men aged 20-40 years.\u00a0Considerable therapeutic improvements in management\u2014based on the cancer&#8217;s responsiveness to chemotherapy that contains platinum\u2014mean that\u00a0over 95% of these patients can now expect to be cured.<br \/>\n<!--more--><br \/>\n<strong>Staging and Risk Stratification of Germ-Cell Tumors<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 14.3493%;\"><strong><span style=\"font-size: 8pt;\">Stage and Risk Category<\/span><\/strong><\/td>\n<td style=\"width: 20.3425%;\"><strong><span style=\"font-size: 8pt;\">Primary Tumor<\/span><\/strong><\/td>\n<td style=\"width: 18.1164%;\"><strong><span style=\"font-size: 8pt;\">Lymph-Node Status<\/span><\/strong><\/td>\n<td style=\"width: 24.6233%;\"><strong><span style=\"font-size: 8pt;\">Metastasis Status<\/span><\/strong><\/td>\n<td style=\"width: 22.5685%;\"><strong><span style=\"font-size: 8pt;\">Serum Tumor-Marker Level<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IA<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea; no involvement\u00a0of the tunica vaginalis<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">No lymph-node involvement or lympho-vascular invasion<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No evidence<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Normal after orchiectomy<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IB<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis and tunica vaginalis,\u00a0spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">No lymph-node involvement; lymphovascular<\/span><br \/>\n<span style=\"font-size: 8pt;\">invasion<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No evidence<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Normal after orchiectomy<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">1S<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea, tunica\u00a0vaginalis, spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">No lymph-node involvement; with or\u00a0without lymphovascular invasion<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No evidence<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Remains elevated and increases after\u00a0orchiectomy<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IIA<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Same as 1S<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">&lt;5 retroperitoneal lymph nodes, each &lt;\/=2 cm<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No evidence<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Normal or slightly high: LDH &lt;1.5\u00d7\u00a0ULN, B-hCG &lt;5000 mIU\/ml, and\u00a0AFP &lt;1000 ng\/ml<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IIB<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea, tunica\u00a0vaginalis, spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">&gt;5 retroperitoneal lymph nodes or at\u00a0least one lymph node &gt;2 cm but &lt;\/=5 cm<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No evidence<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Same as IIA<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IIC<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea, tunica\u00a0vaginalis, spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Retroperitoneal lymph nodes &gt;5 cm<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No evidence<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Same as IIA<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IIIA<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea, tunica\u00a0vaginalis, spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">Distant lymph nodes or\u00a0lungs<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Same as IIA<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IIIB<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea, tunica\u00a0vaginalis, spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">Distant lymph nodes or\u00a0lungs<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">LDH 1.5\u201310\u00d7 ULN, B-hCG 5000\u201350,000 mIU\/ml, AFP 1000\u201310,000\u00a0ng\/ml, or all of these values<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">IIIC<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Involvement of the testis with or without involvement\u00a0of the tunica albuginea, tunica\u00a0vaginalis, spermatic cord, or scrotum<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">Nonpulmonary visceral\u00a0metastases<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Normal or elevated : LDH &gt;10\u00d7 ULN, B-hCG &gt;50,000 mIU\/ml, or AFP\u00a0&gt;10,000 ng\/ml, or all of these\u00a0values<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 100%;\" colspan=\"5\"><strong><span style=\"font-size: 8pt;\">Seminoma<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">Low-risk<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Any primary site<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No nonpulmonary visceral\u00a0metastases<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Normal AFP, any B-hCG, any LDH<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">Intermediate- risk<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Any primary site<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">Nonpulmonary visceral metastases<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Normal AFP, any B-hCG, any LDH<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 100%;\" colspan=\"5\"><strong><span style=\"font-size: 8pt;\">Nonseminomatous\u00a0germ-cell tumor<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">Low-risk<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Testis or retroperitoneal lymph nodes<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No nonpulmonary visceral\u00a0metastases<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">AFP &lt;1000 ng\/ml, B-hCG &lt;5000\u00a0mIU\/ml, and LDH &lt;1.5\u00d7 ULN<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">Intermediate-risk<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Testis or retroperitoneal lymph nodes<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">No nonpulmonary visceral\u00a0metastases<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">AFP &gt;\/=1000 and &lt;\/=10,000 ng\/ml\u00a0or B-hCG &gt;\/=5000 and &lt;\/=50,000\u00a0mIU\/ml or LDH &gt;\/=1.5\u00d7 ULN\u00a0and &lt;\/=10\u00d7 ULN<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 14.3493%;\"><span style=\"font-size: 8pt;\">High-risk<\/span><\/td>\n<td style=\"width: 20.3425%;\"><span style=\"font-size: 8pt;\">Testis or retroperitoneal or mediastinal\u00a0lymph nodes<\/span><\/td>\n<td style=\"width: 18.1164%;\"><span style=\"font-size: 8pt;\">Positive or negative lymph nodes<\/span><\/td>\n<td style=\"width: 24.6233%;\"><span style=\"font-size: 8pt;\">Any site if primary site is\u00a0anterior mediastinal\u00a0lymph nodes; nonpulmonary\u00a0visceral metastases\u00a0if primary site is\u00a0testis or retroperitoneal\u00a0lymph nodes<\/span><\/td>\n<td style=\"width: 22.5685%;\"><span style=\"font-size: 8pt;\">Any of the following levels independently\u00a0confers high risk: AFP\u00a0&gt;10,000 ng\/ml, B-hCG &gt;50,000\u00a0mIU\/ml, or LDH &gt;10\u00d7 ULN<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* AFP denotes alpha-fetoprotein, B-hCG beta human chorionic gonadotropin, LDH lactate dehydrogenase, and ULN upper limit of the normal range.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Hanna NH, Einhorn LH. Testicular cancer&#8211;discoveries and updates. N Engl J Med. 2014 Nov 20;371(21):2005-16.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25409373\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>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.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18790940\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Oliveira-Lopes B, Tavares NT, Lobo J. Testicular germ cell tumors and molecular biomarkers. Curr Opin Urol. 2026 Mar 1;36(2):205-211. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41128509\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Mar 04, 2015<br \/>\nUp-date Apr 6, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[298],"tags":[757,756,840,839,838,837,836,767,835,834,745,744],"class_list":["post-2352","post","type-post","status-publish","format-standard","hentry","category-urology","tag-cell","tag-celulas","tag-estadificacion","tag-estratificacion","tag-germ","tag-germinales","tag-riesgo","tag-risk","tag-staging","tag-stratification","tag-tumores","tag-tumors"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2352","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2352"}],"version-history":[{"count":6,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2352\/revisions"}],"predecessor-version":[{"id":10733,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2352\/revisions\/10733"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2352"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2352"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2352"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}