TNM Classification of Testicular Tumors

Description

A malignant tumor of the testis can be staged using the TNM classification system. The testicular coding also incorporates an S code for serum levels of tumor markers.

Group	Description	Code
T	primary tumor cannot be assessed	TX
	no evidence of primary tumor	T0
	intratubular germ cell neoplasia (carcinoma in situ)	Tis
	tumor limited to the testis and epididymis without vascular or lymphatic invasion; tumor may invade the tunica albuginea but not the tunica vaginalis	T1
	tumor limited to the testis and epididymis with vascular or lymphatic invasion, OR invasion through the tunica albuginea with involvement of the tunica vaginalis	T2
	tumor invades the spermatic cord (vas deferens) with or without vascular/lymphatic invasion	T3
	tumor invades into scrotum with or without vascular/lymphatic invasion	T4
N	regional lymph nodes cannot be assessed	NX
	no regional lymph node metastasis	N0
	metastasis with a lymph node mass <= 2 cm in greatest dimension; <= 5 lymph nodes with metastasis, none more than 2 cm in diameter	N1
	metastasis with a lymph node mass > 2 cm in diameter but <= 5 cm in greatest dimension; or > 5 nodes positive, none > 5 cm in diameter; or extranodal extension of tumor	N2
	metastasis with a lymph node mass > 5 cm in greatest dimension	N3
M	presence of distant metastasis cannot be assessed	MX
	no definite metastasis	M0
	distant metastasis present	M1
	non-regional lymph nodes or pulmonary metastasis	M1a
	distant metastasis other than to non-regional lymph nodes and lungs	M1b
S	marker studies not available or performed	SX
	markers studies within normal limits	S0
	LDH < 1.5 times ULN AND hCG < 5,000 IU/L AND AFP < 1,000 ng/mL	S1
	LDH >= 1.5 times ULN AND <= 10 times ULN, OR hCG >= 5,000 IU/L AND <= 50,000 IU/L, OR AFP >= 1,000 ng/mL AND <= 10,000 ng/mL	S2
	LDH > 10 times ULN OR hCG > 50,000 IU/L OR AFP > 10,000 ng/mL	S3

where:

• 1 IU/L = 1 mIU/mL

• ULN = upper limit for the normal reference range

• Regional lymph nodes include: interaortocaval, para-aortic, paracaval, preaortic, precaval, retroaortic and retrocaval groups.

Additional Codes	Meaning	Example
R	residual tumor (R0 = none; R1 = microscopic; R2 = macroscopic)
y	residual tumor present	ypT1
r	local recurrence following a previous resection	rpT1

TNM	Stage
Tis N0 M0 S0	0
T1-4 N0 M0 SX	I
T1 N0 M0 S0	IA
T2-4 N0 M0 S0	IB
T1-4 N0 M0 S1-3	IS
T1-4 N1-3 M0 SX	II
T1-4 N1 M0 S0	IIA
T1-4 N2 M0 S0-1	IIB
T1-4 N3 M0 S0-1	IIC
T1-4 N1-3 M1 SX	III
T1-4 N1-3 M1a S0-1	IIIA
T1-4 N1-3 M0-1a S2	IIIB
T1-4 N1-3 M0-1a S3 T1-4 N1-3 M1b S1-3	IIIC

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Description

Specialty

ICD-10