So after discussing the normal anatomy of the testis, we now come to the T staging for testicular tumors. This figure shows the T1 stage in which the tumor is limited to the testis. It may invade the tunica albuginea but not the tunica vaginalis.
There is no lymphovascular invasion by the tumor. In this figure also we see the T1 disease, which is localized to the testis, not invading tunica vaginalis. Next comes the T2 disease. In this, the disease is limited to the testis or epididymis. The tumor may extend through tunica albuginea to involve tunica vaginalis, or there might be the lymphovascular invasion by the tumor.
This figure also shows the T2 disease, with infiltration of the tumor into the tunica vaginalis. This figure shows T3 disease in which the tumor infiltrates into the spermatic cord. And here the tumor infiltrates into the scrotum, called as T4. So after the T staging, comes the N staging or the nodal staging. The absence of regional lymph nodes is called as N0, whereas, the involvement of regional lymph nodes is called as N1, N2 or N3 depending upon the size and the number of the nodes.
These nodal structures called retroperitoneal lymph nodes are the regional lymph nodes for testicular cancer. Their size and number determine the N-stage, that is N1, N2 or N3. After the T and N staging, comes the M staging for testicular cancer. It is called as M1a if there is spread to non-regional lymph nodes, that is, any nodes except retroperitoneal lymph nodes as discussed above, or if there is spread to lungs that are called as pulmonary metastasis.
Whereas spread to the organs than lungs is called as M1b. This figure shows M1a disease due to the involvement of lymph nodes in the mediastinum, this is non-regional lymph nodes because it is outside the retroperitoneum. Similarly, the involvement of inguinal lymph nodes is also M1a disease because it is a non-regional lymph node for testis.
And here, the involvement of supraclavicular lymph node is non-regional. M1a disease also includes the cases with pulmonary metastasis, that is spread of the tumor to lungs. Whereas, spread to the organs of the body other than lung is called as M1b. In this figure spread to liver makes it M1b.
Spread to brain or bones is also M1b. So with this, we come to the end of TNM testicular cancer staging.
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