After the initial radical orchiectomy, which gives the physician the first staging information, other tests have to be done for staging of testicular cancer. This is required in order to assess how widespread the testicular cancer is.
After all the tests are completed, the physician can determine which cancer stage the patient is in. This cannot be overemphasized as the best cancer treatment result depends on the initial accurate staging. Chest X-rays are done to rule out lung metastases.
A CT scan of any positive lung lesions would be done to be able to follow the disease under treatment. Retroperitoneal involvement of lymph glands is tested with abdominal CT scans. The blood tests already mentioned above are also taken into account. Here are the stages that the patient possibly might be found in (modified according to Ref. 1, p.1129):
Staging of testicular cancer (seminoma)
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Stage (Boden-Gibb):
I : cancer confined to testicle
II : cancer spread to regional lymph nodes
III : cancer spread beyond retroperitoneal lymph nodes
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Apart from this staging system there are several others, but the principle is always that earlier stages are associated with “good risk” and the later stages are of a “poorer risk”.
Late stage testicular cancer with blockage of right leg lymphatic drainage (lymphedema)
The Indiana University Staging System distinguishes minimal extent disease, moderate extent disease and advanced extent disease (see Ref. 1, p.1140). This way prognostic factors such as tumor size, whether or not several anatomic sites are involved, the histology, the staging and other information can be incorporated in the treatment planning.
References:
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Cancer of the Testis.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Cancer of the Testis.
3. Votrin II et al. Drugs Exp Clin Res 2000;26(5-6):267-273.
4. B Aschhoff Drugs Exp Clin Res 2000;26(5-6):249-252.
5. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
