19: Neoplasms of the male genitalia

Question 1

Explain the serum tumor marker (S) classifications in TNM Staging of Testicular Tumor, including the criteria for S1, S2, and S3.

Answer 1

Serum tumor markers (S) in TNM Staging classify the level of tumor markers in the blood:

S1: LDH <1.5 × N, hCG <5000 MIU/mL, AFP <1000 ng/mL
S2: LDH 1.5-10 × N, hCG 5000–50,000 MIU/mL, AFP 1000–10,000 ng/mL
S3: LDH >10 × N, hCG >50,000 MIU/mL, AFP >10,000 ng/mL

Question 2

Describe the Stage Grouping of Testicular Tumor in the TNM Staging system, focusing on the characteristics of Stage IIA.

Answer 2

Stage IIA in the TNM Staging of Testicular Tumor includes:

Any pT/Tx
N1 regional lymph node metastasis
M0 (no distant metastasis)
S0 or S1 serum tumor markers

Question 3

What does the regional lymph node (N) classification in the TNM Staging of Testicular Tumor describe, specifically N2 and N3?

Answer 3

N2 refers to Metastasis with lymph node mass >2 cm but not more than 5 cm in greatest dimension or multiple lymph nodes, any one mass >2 cm but not more than 5 cm. N3 refers to Metastasis with lymph node mass >5 cm in greatest dimension.

Question 4

Define the classifications of the primary tumor (T) in the TNM Staging of Testicular Tumor. Explain the meaning of pT0 and pT1.

Answer 4

Primary tumor classifications are assessed after radical orchiectomy.

pT0: No evidence of primary tumor (e.g., histologic scar in testis).
pT1: Tumor limited to testis and epididymis without vascular/lymphatic invasion; may invade into tunica albuginea but not tunica vaginalis.

Question 5

What does “pT1” represent in the TNM Staging of Testicular Cancer?

Answer 5

pT1 indicates a tumor limited to testis and epididymis without vascular/lymphatic invasion; it may invade into tunica albuginea but not tunica vaginalis.

Question 6

Describe “pT2” in the TNM Staging of Testicular Cancer.

Answer 6

pT2 refers to a tumor limited to testis and epididymis with vascular/lymphatic invasion or tumor extending through tunica albuginea with involvement of tunica vaginalis.

Question 7

What does “pT3” mean in the TNM Staging of Testicular Cancer?

Answer 7

pT3 means the tumor invades the spermatic cord with or without vascular/lymphatic invasion.

Question 8

Define “pT4” in the TNM Staging of Testicular Cancer.

Answer 8

pT4 means the tumor invades the scrotum with or without vascular/lymphatic invasion.

Question 9

Define “N1” in the TNM Staging of Testicular Cancer.

Answer 9

N1 refers to metastasis with lymph node mass ≤2 cm in greatest dimension or multiple lymph nodes, none more than 2 cm in greatest dimension.

Question 10

What does “N2” represent in the TNM Staging of Testicular Cancer?

Answer 10

N2 means metastasis with lymph node mass >2 cm but not more than 5 cm in greatest dimension or multiple lymph nodes, any one mass >2 cm but not more than 5 cm in greatest dimension.

Question 11

Describe “N3” in the TNM Staging of Testicular Cancer.

Answer 11

N3 refers to metastasis with lymph node mass >5 cm in greatest dimension.

Question 12

What does “pN1” represent in the TNM Staging of Testicular Cancer?

Answer 12

pN1 refers to metastasis with lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none more than 2 cm in greatest dimension.

Question 13

Describe “pN2” in the TNM Staging of Testicular Cancer.

Answer 13

pN2 means metastasis with lymph node mass >2 cm but not more than 5 cm in greatest dimension; or >5 nodes positive, none more than 5 cm; or evidence of extranodal extension of tumor.

Question 14

What does “pN3” mean in the TNM Staging of Testicular Cancer?

Answer 14

pN3 refers to metastasis with lymph node mass >5 cm in greatest dimension.

Question 15

Describe “M1a” in the TNM Staging of Testicular Cancer.

Answer 15

M1a refers to nonregional nodal or pulmonary metastasis.

Question 16

What does “M1b” mean in the TNM Staging of Testicular Cancer?

Answer 16

M1b means distant metastasis at a site other than nonregional lymph nodes or lung.

Question 17

Describe “Stage 0” in the TNM Staging of Testicular Cancer.

Answer 17

Stage 0 consists of pTis, N0, M0, S0.

Question 18

What does “Stage I” encompass in the TNM Staging of Testicular Cancer?

Answer 18

Stage I includes pT1-4, N0, M0, SX.

Question 19

Describe the subcategories within “Stage II” in the TNM Staging of Testicular Cancer.

Answer 19

Stage II includes Stage IIA (Any pT/Tx, N1, M0, S0/S1), Stage IIB (Any pT/Tx, N2, M0, S0/S1), and Stage IIC (Any pT/Tx, N3, M0, S0/S1).

Question 20

What does “Stage III” represent in the TNM Staging of Testicular Cancer, including subcategories?

Answer 20

Stage III includes Stage IIIA (Any pT/Tx, Any N, M1a, S0/S1), Stage IIIB (Any pT/Tx, N1-3, M0, S2 or Any N, M1a, S2), and Stage IIIC (Any pT/Tx, N1-3, M0, S3 or Any N, M1a, S3 or Any N, M1b, Any S).