There are four main stages of testicular cancer. In the initial stages, precancerous cells are present in the testicles. In later stages, the cancer has spread to distant parts of the body.

In its earlier stages, symptoms may only affect the testicles. For instance, a person might experience testicular pain, growths, or swelling.

However, the American Cancer Society (ACS) notes that testicular cancer can manifest in many ways if it reaches other organs. These symptoms can include shortness of breath, back pain, abdominal pain, and headaches.

Although treatment is effective at any stage, a person’s outlook is better if the cancer is treated in the earlier stages.

After explaining how staging works, this article provides detailed descriptions of the stages of testicular cancer. It also discusses how the treatment and outlook changes depending on the stage of cancer.

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Testicular cancer is when cells within the testicles grow at an abnormal rate. Over time, these cancer cells could form tumors or spread to other body parts.

As the ACS explains, staging is the process doctors use to assess how much a person’s cancer has grown, and the degree to which it might have spread.

This information can be very useful for treatment purposes. It can also give an accurate outlook on a person’s testicular cancer.

The main staging system for testicular cancer is as follows:

  • T — tumor: This refers to the extent and size of the tumor.
  • N — nodes: This describes whether the cancer has spread to the lymph nodes.
  • M — metastasis: This refers to whether the cancer has spread to distant body parts.
  • S — serum levels of tumor markers: Tumor markers are chemicals that cancer cells sometimes release into the bloodstream. They can help doctors track a cancer’s development. Tumor markers for testicular cancer include lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG).

According to the National Cancer Institute (NCI), stage 0 involves abnormal cells in the small tubes in each testicle, called seminiferous tubules. These abnormal cells have the potential to become cancerous but have not yet done so.

At this stage, tumor markers are normal.

The stage grouping for stage 0 testicular cancer is:

  • pTis: The cancer has not spread to other parts of the testicles.
  • N0: The cancer has not spread to nearby lymph nodes.
  • M0: The cancer has not spread to distant parts of the body.
  • S0: The tumor marker levels are normal.

As the NCI explains, stage 1 testicular cancer is when cancer has formed in the testicle. Doctors divide it further into three stages: 1a, 1b, and 1s.

Stage 1a means the cancer is in the testicle but has not spread, and tumor markers are normal. By contrast, stage 1b means the cancer has spread to other tissues in the area.

At stage 1b, tumor markers are normal. This is not the case for stage 1s, where they might be slightly above normal or even high. Additionally, the cancer has spread to the spermatic cord or the scrotum.

The stage grouping system for stage 1 testicular cancer is:

  • pT1–4: The tumor could be confirmed to the testis or has spread beyond the tubes in the testicles and to the nearby structures.
  • N0: The cancer has not spread to nearby lymph nodes.
  • M0: The cancer has not spread to distant parts of the body.
  • SX: The results of the tumor marker tests are not available, or a doctor has not yet performed the tests. This can change to S1–3 for stage 1s.

According to the NCI, there are three substages of stage 2 testicular cancer: 2a, 2b, and 2c. In all these substages, the cancer has spread to the lymph nodes.

Furthermore, tumor markers are either normal or slightly above normal.

In stage 2a, the cancer has spread to one to five nearby lymph nodes, which are 2 centimeters (cm) or smaller.

In stage 2b, the cancer has spread in any of the following ways:

  • to one nearby lymph node, which is larger than 2 cm but not larger than 5 cm
  • to more than five nearby lymph nodes, which are not larger than 5 cm
  • to a nearby lymph node and outside of it

In stage 2c, the cancer has spread to a nearby lymph node larger than 5 cm.

The stage grouping for stage 2 testicular cancer is as follows:

  • Any pT, or TX: The tumor may or may not have spread beyond the testicle. “TX” means that healthcare professionals could not assess the extent of the tumor.
  • N1–3: The cancer has spread to one or more lymph nodes nearby.
  • M0: The cancer has not spread to distant parts of the body.
  • SX, or S0–1: The results of the tumor marker tests are not available, or a doctor has not yet performed the tests. This can change to S0 or S1. “S0” means the tumor marker levels were normal. “S1” means the levels are slightly above normal.

As the NCI explains, there are also three substages of stage 3 testicular cancer: 3a, 3b, and 3c. In all these substages, the cancer may have spread into the spermatic cord or the scrotum.

It also means the cancer has spread to another organ, or the tumor marker levels are very high. The cancer has also spread to the lymph nodes.

In stage 3a, tumor markers are normal or slightly above normal. The cancer may have spread to at least one nearby lymph node. The cancer has also spread to distant lymph nodes or to the lungs.

The staging group for stage 3a is:

  • Any pT: The tumor may or may not have grown outside of the testicle.
  • Any N: The cancer may have spread to nearby lymph nodes.
  • M1a: The cancer has spread to the lungs or distant lymph nodes.
  • S0 or S1: All tumor marker levels or normal, or there is at least one tumor marker that is higher than normal.

In stage 3b, tumor markers are moderately above normal. The cancer has also spread to at least one nearby lymph node and in any of the following ways:

  • not to other body parts
  • to distant lymph nodes or to the lungs

There are two ways for testicular cancer to qualify as stage 3c. The first way is for at least one tumor marker to be high. Additionally, the cancer has spread to at least one nearby lymph node and in any of the following ways:

  • not to other parts of the body
  • to distant lymph nodes or to the lungs

The second way is for the cancer to spread to other parts of the body, like the liver or bones. Tumor markers may be normal or high, but the cancer has not spread to distant lymph nodes or the lungs.

The staging group for stage 3b is:

  • Any pT: This means the tumor may or may not have grown outside of the testicle.
  • Any N or N1–3: The cancer has spread to one or more nearby lymph nodes.
  • M0 or M1a: The cancer has not spread to the lungs or distant lymph nodes. Alternatively, it may have spread to distant parts of the body or the lungs.
  • S2: At least one tumor marker is higher than normal.

Treatment for testicular cancer can be highly effective, allowing people to live cancer-free for many years.

However, the NCI points out that cancer can return after treatment. This is called recurrent testicular cancer. Cancer may come back soon after treatment or return years after treatment. The cancer could arise in the testicles. It could also come back in other body parts.

The treatment for testicular cancer varies with its stages.

According to the NCI, doctors may treat stage 0 testicular cancer with:

Doctors may treat stage 1 testicular cancer by:

  • surgically removing the testicle
  • surgically removing the testicle and nearby lymph nodes
  • surgically removing the testicle plus chemotherapy or watchful waiting

As for stage 2 testicular cancer, doctors may recommend the following treatments:

  • surgical removal of the testicle and nearby lymph nodes
  • surgical removal of the testicle plus radiation therapy to nearby lymph nodes
  • combination chemotherapy
  • surgical removal of the testicle, long-term follow-ups, and either radiation therapy or combination chemotherapy
  • surgical removal of the testicle plus combination chemotherapy with a possible second surgery

Doctors can treat stage 3 testicular cancer with the following interventions:

  • surgical removal of the testicle, plus combination chemotherapy
  • combination chemotherapy plus surgical removal of the testicle and any other tumors

Finally, typical treatment options for recurrent testicular cancer include:

  • surgery
  • high dose chemotherapy plus stem cell transplant
  • combination chemotherapy

Some people may also wish to take part in a clinical trial.

The outlook for people with testicular cancer is positive: The 5-year survival rate for testicular cancer is over 95%, and the overall cure rate is roughly 90%

The ACS outlines the following 5-year relative survival rates depending on the stage of cancer:

Stage5-year relative survival rate
Localized (cancer has not spread beyond the testicles)99%
Regional (cancer has spread beyond the testicle and to nearby lymph nodes)96%
Distant (cancer has spread to distant parts of the body)73%
All stages combined95%

In the earliest stages of testicular cancer, there are only a few abnormal cells in the testicles, and tumor markers are normal. But as the cancer develops, this can change. For instance, tumor markers may increase, and the cancer can spread throughout the testicles.

Untreated testicular cancer makes its way into lymph nodes or even spreads to distant organs. The outlook for people with this type of cancer decreases as the cancer advances. However, treatment for testicular cancer is extremely effective.