Testicular Cancer Stages and Classifications
Testicular Cancer Staging: TNM, Tumor Markers, and IGCCCG Risk Groups
Last updated and reviewed on June 28, 2026.
Once testicular cancer is diagnosed by removing and examining the testicle, the next step is staging. Staging determines how far the cancer has spread beyond the testicle, which is the most important factor in deciding what treatment is needed and what outcomes to expect. Testicular cancer uses the TNM staging system, but it has a unique feature that distinguishes it from most other cancers: tumor marker levels in the blood are formally incorporated into the staging system as an S category. This makes testicular cancer staging one of the few systems in oncology where a blood test is part of the official staging.
The TNM Staging System for Testicular Cancer
T stands for Tumor and describes how far the primary tumor has grown within and around the testicle.
- pT1 means the tumor is confined to the testicle and epididymis, has not grown into blood or lymph vessels within the testicle, and has not penetrated the outer covering of the testicle (the tunica vaginalis). For seminoma, pT1 is further divided into pT1a (smaller than 3 cm) and pT1b (3 cm or larger).
- pT2 means the tumor is confined to the testicle but has grown into blood or lymph vessels within the testicle (lymphovascular invasion), or has grown into the outer covering of the testicle.
- pT3 means the tumor has grown into the spermatic cord.
- pT4 means the tumor has grown into the scrotal wall.
N stands for Nodes and describes whether the cancer has spread to the lymph nodes in the retroperitoneum (the back of the abdomen).
- N0 means there are no enlarged lymph nodes on imaging.
- N1 means there are enlarged lymph nodes measuring 2 cm or smaller.
- N2 means lymph nodes are between 2 and 5 cm in size, or there are multiple enlarged lymph nodes, none larger than 5 cm.
- N3 means one or more lymph nodes are larger than 5 cm.
M stands for Metastasis and describes whether the cancer has spread to distant sites.
- M0 means no distant spread.
- M1a means the cancer has spread to distant lymph nodes or the lungs.
- M1b means the cancer has spread to other distant organs, such as the liver, bones, or brain.
S stands for Serum Tumor Markers and is unique to testicular cancer staging.
- S0 means all marker levels are within the normal range after surgery.
- S1 means LDH is less than 1.5 times the upper limit of normal, hCG is less than 5,000 mIU/mL, and AFP is less than 1,000 ng/mL.
- S2 means LDH is 1.5 to 10 times normal, hCG is between 5,000 and 50,000, or AFP is between 1,000 and 10,000.
- S3 means LDH is more than 10 times normal, hCG is more than 50,000, or AFP is more than 10,000.
The Overall Stage Groups
Combining the T, N, M, and S values, doctors assign an overall stage:
| Stage | Stage Grouping | What It Means |
|---|---|---|
|
0 |
pTis |
The cancer is only in the seminiferous tubules (small tubes inside each testicle). It has not grown into other parts of the testicle (pTis). It hasn't spread to nearby lymph nodes (N0) or to distant parts of the body (M0). All tumor marker levels are within normal limits (S0). |
|
I |
pT1-pT4 |
The tumor has grown beyond the seminiferous tubules and might have grown outside the testicle and into nearby structures (pT1-pT4). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). Tumor marker test results aren’t available, or the tests haven’t been done (SX). |
|
IA |
pT1 |
The tumor has grown beyond the seminiferous tubules, but is still within the testicle, and it hasn't grown into nearby blood vessels or lymph nodes (pT1). The cancer hasn't spread to nearby lymph nodes (N0) or to distant parts of the body (M0). All tumor marker levels are within normal limits (S0). |
|
IB |
pT2-pT4 |
The tumor has grown outside of the testicle and into nearby structures (pT2-pT4). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). All tumor marker levels are within normal limits (S0). |
|
IS |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). At least one tumor marker level is higher than normal (S1-S3). |
|
II |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to 1 or more nearby lymph nodes (N1-N3), but it hasn't spread to distant parts of the body (M0). Tumor marker test results aren’t available, or the tests haven’t been done (SX). |
|
IIA |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to at least 1 nearby lymph node (but no more than 5, if checked by surgery), and none of the lymph nodes are larger than 2 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0). All tumor marker levels are within normal limits (S0), or at least 1 tumor marker level is slightly higher than normal (S1). |
|
IIB |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to at least 1 nearby lymph node that's larger than 2 cm but no larger than 5 cm across, OR it has grown outside of a lymph node, OR more than 5 nodes contain cancer (found during surgery) (N2). The cancer has not spread to distant parts of the body (M0). All tumor marker levels are within normal limits (S0), or at least 1 tumor marker level is slightly higher than normal (S1). |
|
IIC |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to at least 1 nearby lymph node that's larger than 5 cm across (N3). The cancer has not spread to distant parts of the body (M0). All tumor marker levels are within normal limits (S0), or at least 1 tumor marker level is slightly higher than normal (S1). |
|
III |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant parts of the body (M1). Tumor marker test results aren’t available, or the tests haven’t been done (SX). |
|
IIIA |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes or to the lungs (M1a). All tumor marker levels are within normal limits (S0), or at least 1 tumor marker level is slightly higher than normal (S1). |
|
IIIB
|
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to 1 or more nearby lymph nodes (N1-N3), but it hasn't spread to distant parts of the body (M0). At least 1 tumor marker level is much higher than normal (S2). |
|
OR |
||
|
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes or to the lungs (M1a). At least 1 tumor marker level is much higher than normal (S2). |
|
| IIIC |
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to 1 or more nearby lymph nodes (N1-N3), but it hasn't spread to distant parts of the body (M0). At least 1 tumor marker level is very high (S3). |
|
OR |
||
|
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes or to the lungs (M1a). At least 1 tumor marker level is very high (S3). | |
|
OR |
||
|
Any pT (or TX) |
The tumor might or might not have grown outside the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant parts of the body other than the lymph nodes or to the lungs (M1b). Tumor marker levels might or might not be higher than normal (any S). | |
The International Germ Cell Cancer Collaborative Group (IGCCCG) Classification
Beyond the formal TNM staging system, oncologists who treat testicular cancer frequently use a prognostic classification developed by the International Germ Cell Cancer Collaborative Group (IGCCCG). This classification is used specifically for metastatic testicular cancer (Stage II and III disease) and divides patients into good prognosis, intermediate prognosis, and poor prognosis categories based on the tumor type, the sites of metastasis, and the tumor marker levels.
- Good prognosis applies to the large majority of patients with testicular germ cell tumors and is associated with a five-year survival rate of 92 to 96 percent with standard BEP chemotherapy.
- Intermediate prognosis is associated with a five-year survival rate of approximately 80 percent.
- Poor prognosis is associated with a five-year survival rate of approximately 48 to 54 percent, and these patients are often enrolled in clinical trials exploring more intensive or novel treatment approaches.
Understanding your IGCCCG risk group, if you have metastatic disease, is an important part of the treatment planning conversation with your oncologist.
A note on seeking expert care: Testicular cancer staging and treatment planning involve decisions that benefit greatly from specialist expertise. Treatment at a high-volume center with a dedicated genitourinary oncology program, or at least with a medical oncologist who has substantial experience treating testicular cancer, is associated with better outcomes. If you have any doubt about whether your care team has this experience, asking for a consultation at a major cancer center is entirely appropriate.
What’s Next: The next page in this guide is How Testicular Cancer Is Treated. If you would like to read another page in this guide, return to the Testicular Cancer 101 Guides page or choose another topic.
Sources
- American Cancer Society. Testicular Cancer Stages. https://www.cancer.org/cancer/types/testicular-cancer/detection-diagnosis-staging/staging.html
- American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 8th Edition. Testis chapter. 2018. https://staging.seer.cancer.gov/eod_public/input/1.4/testis/ss2018/?version=/tnm/home/1.9/
- National Cancer Institute. Testicular Cancer Treatment (PDQ) Patient Version. https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq
- Albers P, et al. EAU Guidelines on Testicular Cancer. European Urology. 2023. https://www.europeanurology.com/article/S0302-2838(23)02732-X/fulltext