An instrument that doctors use to describe the stages of cancer is the TNM system. For testicular cancer, an S is added to the TNM system, called the serum tumor marker (S): Are the markers of AFP, beta-hCG and LDH serum tumors at high concentrations?

Stages provide a common way to describe how advanced cancer is, so physicians can plan the best treatments.

Tumor (T) – For Testicular Cancer, stage T can only be determined when tissue removed during surgery is examined under a microscope; this means that stage T is determined only after the testicle is removed, and it is always a pathological stage and never a clinical stage. “P” before stage T indicates that it is a pathological step:

• pTX: Primary tumor cannot be evaluated.
• pT0: There is no evidence of a primary tumor in the testicles.
• pT1: the primary tumor is only in the testicle with or without the involvement of the epididymis, has not developed into blood vessels or lymph vessels from the testes.
• pT2: the tumor is in the testicle, with or without epididymal involvement.
• pT3: The tumor increased in the sperm cord.
• pT4: The tumor has grown in the scrotum.

Node (N) – represents lymph nodes; when a stage has been pathologically determined, the letter “p” is added as the first letter of the step (eg, pN1) and the letter “c” represents the clinical stage:

• NX: regional lymph nodes cannot be evaluated.
• cN0: there is no spread to regional lymph nodes, as seen in imaging tests.
• pN0: no cancer cells in the lymph nodes;
• cN1: imaging tests show that cancer cells spread to 1 or more lymph nodes in the retroperitoneum and none of the lymph nodes is greater than 2 cm;
• pN1: Cancer is present in 1-5 lymph nodes, but none is greater than 2 cm;
• cN2: imaging tests indicate at least one size of lymph nodes or lymph nodes in retroperitoneum greater than 2 cm but not more than 5 cm;
• pN2: any or both of the following conditions: there is cancer in more than 5 lymph nodes, but none is more than 5 cm, there is cancer in at least 1 lymph node, and the largest mass of lymph nodes or lymph nodes exceeds 2 cm but not more than 5 cm;
• cN3: Imaging tests have at least one enlarged lymph node or a mass of lymph nodes in retroperitoneum greater than 5 cm;
• pN3: There are cancerous cells in at least 1 ganglion, larger than 5 cm.

Metastasis (M)

• MX: remote metastases cannot be evaluated;
• M0: the disease did not metastasize to distal lymph nodes or other organs;
• M1: There is at least one remote metastasis:
• M1a: there are cancer cells in the lymph nodes removed and/or in the lungs;
• M1b: cancer has spread to organs other than lungs.

Serum tumor markers (S) – certain tumor markers decrease in concentration, usually after surgery:

• SX: tumor marker level is not available or tests have not been performed;
• S0: tumor marker level is normal;
• S1: at least one level of tumor markers is above normal;
• S2: at least one level of the tumor marker is substantially higher than normal.
• S3: one or more tumor markers have too high values;