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Royal Marsden Hospital Classification Testicular Cancer

Purpose: To evaluate a male with a testicular cancer using the staging system developed at Royal Marsden Hospital.

Description

A staging system for testicular cancer was developed at the Royal Marsden Hospital. It applies to both seminomas and nonseminomatous germ cell tumors. The Royal Marsden Hospital is in London.


Serum markers:

(1) alpha fetoprotein (AFP)

(2) beta human chorionic gonadotropin (HCG)

 

Clinical Extent

Stage

no physical evidence of metastases

I

metastases to abdominal lymph nodes

II

metastases to supradiaphragmatic lymph nodes

III

metastases to extralymphatic sites

IV

 

 

Clinical Findings

Stage

no evidence of metastases and no elevation of serum markers

I

elevation of serum markers but no other evidence of metastases

IM

metastases to abdominal lymph nodes (see below)

II-ABC

metastases to mediastinal lymph nodes

III-M

metastases to supraclavicular, cervical and/or axillary lymph nodes

III-N

metastases to abdominal lymph nodes (see below)

III-OABC

lung metastases (see below)

IV-L1 to L3

metastases to liver

IV-H+

metastases to brain

IV-Br+

metastases to bone

IV-Bo+

 

 

Abdominal Lymph Node Metastases

Subcode

< 2 cm in diameter

A

2 - 5 cm in diameter

B

> 5 cm in diameter

C

 

 

Lung Metastases

Subcode

1 - 3 metastases

L1

> 3 metastases, largest <= 2 cm in diameter

L2

> 3 metastases, largest > 2 cm in diameter

L3

 

 

Worse prognosis is associated with:

(1) Stage IIC (and probably Stage IIIC)

(2) Stage IV L3

(3) Stage IV H+

(4) Stage IV Bo+


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Specialty

Objective

ICD-10