TNM 7 Classification
TNM 6 Classification
1. Rules for Classification
The classification applies only to germ cell tumours of the testis. There should be histological confirmation of the disease and division of cases by histological type. Histopathological grading is not applicable.
The presence of elevated serum tumour markers, including alphafetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH), is frequent in this disease. Staging is based on the determination of the anatomic extent of disease and assessment of serum tumour markers.
The following are the procedures for assessing N, M, and S categories:
- N categories. Physical examination and imaging
- M categories. Physical examination, imaging, and biochemical tests
- S categories. Serum tumour markers
2. Regional Lymph NodesThe regional lymph nodes are the abdominal para-aortic (periaortic), preaortic, interaortocaval, precaval, paracaval, retrocaval, and retroaortic nodes. Nodes along the spermatic vein should be considered regional. Laterality does not affect the N classification. The intrapelvic nodes and the inguinal nodes are considered regional after scrotal or inguinal surgery.
3. TNM Clinical Classification3.1. T - Primary Tumour
Except for pTis and pT4. where radical orchiectomy is not always necessary for classification purposes, the extent of the primary tumour is classified after radical orchiectomy; see pT. In other circumstances, TX is used if no radical orchiectomy has been performed.
3.2. N - Regional Lymph Nodes
NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Metastasis with a lymph node mass 2 cm or less in greatest dimension or multiple lymph nodes, none more than 2 cm in greatest dimension
N2. Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, any one mass more than 2 cm but not more than 5 cm in greatest dimension
N3. Metastasis with a lymph node mass more than 5 cm in greatest dimension
3.3. M - Distant Metastasis
MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis
M1a. Non-regional lymph node(s) or lung
M1b. Other sites
4. pTNM Pathological ClassificationSee also: Additional site-specific recommendations for pT and pN
4.1. pT - Primary Tumour
pTX. Primary tumour cannot be assessed (see T - Primary Tumour, above)
pT0. No evidence of primary tumour (e.g. histologic scar in testis)
pTis. Intratubular germ cell neoplasia (carcinoma in situ)
pT1. Tumour limited to testis and epididymis without vascular/lymphatic invasion; tumour may invade tunica albuginea but not tunica vaginalis.
pT2. Tumour limited to testis and epididymis with vascular/lymphatic invasion, or tumour extending through tunica albuginea with involvement of tunica vaginalis.
pT3. Tumour invades spermatic cord with or without vascular/lymphatic invasion.
pT4. Tumour invades scrotum with or without vascular/ lymphatic invasion.
4.2. pN - Regional Lymph Nodes
pNX. Regional lymph nodes cannot be assessed
pN0. No regional lymph node metastasis
pN1. Metastasis with a lymph node mass 2 cm or less in greatest dimension and 5 or fewer positive nodes, none more than 2 cm in greatest dimension
pN2. Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension of tumour
pN3. Metastasis with a lymph node mass more than 5 cm in greatest dimension
4.3. pM - Distant Metastasis
The pM category corresponds to the M category.
4.4. S - Serum Tumour Markers
SX. Serum marker studies not available or not performed
S0. Serum marker study levels within normal limits
5. Stage Grouping