TNM and Serum Marker Definitions for Testicular Cancer*

Tumor

pTX

Not assessable

pT0

No evidence of primary tumor (eg, scar in testis)

pTis

Intratubular germ cell tumors (carcinoma in situ)

pT1

Limited to testis and rete testis without vascular or lymphatic invasion

May invade tunica albuginea but not tunica vaginalis

pT1a

Seminoma < 3 cm

pT1b

Seminoma ≥ 3 cm

pT2

Limited to testis and epididymis with vascular or lymphatic invasion, or extends through tunica albuginea and involves tunica vaginalis

pT3

Invades spermatic cord with or without vascular or lymphatic invasion

pT4

Invades scrotum with or without vascular or lymphatic invasion

Regional lymph node metastasis

NX

Not assessable

N0

None

N1

≥ 1 node but not more than 5 nodes, all ≤ 2 cm in greatest dimension

N2

≥ 1 node > 2 cm but ≤ 5 cm in greatest dimension, or more than 5 nodes ≤ 5 cm in greatest dimension

N3

≥ 1 node > 5 cm in greatest dimension

Distant metastasis

MX

Not assessable

M0

None

M1

Present

M1a

Nonretroperitoneal nodal or lung metastasis

M1b

Distant metastasis other than nonregional lymph nodes or lung

Serum markers

SX

Markers not available or not measured

S0

Levels within normal limits

S1

LDH < 1.5 × the upper limit of normal for the LDH assay and beta-hCG < 5000 mIU/mL and AFP < 1000 ng/mL

S2

LDH = 1.5–10 × upper limit of normal for the LDH assay or beta-hCG 5000–50,000 mIU/mL or AFP 1000–10,000 ng/mL

S3

LDH > 10 × upper limit of normal for the LDH assay or hCG > 50,000 mIU/mL or AFP >10,000 ng/mL