Key Points
                    - After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body.     - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - The following stages are used for testicular cancer:         - Stage 0 (Testicular Intraepithelial Neoplasia)     - Stage I     - Stage II     - Stage III
                
                
                    After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body.
                    The process used to find out if cancer has spread within the testicles or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.    The following tests and procedures may be used in the staging process:         -   Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.     -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).    -   Abdominal lymph node dissection : A surgical procedure in which lymph nodes in the abdomen are removed and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy.     -   Serum tumor marker test : A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumor markers are used in staging testicular cancer:               -  Alpha-fetoprotein (AFP)      -  Beta-human chorionic gonadotropin (-hCG).       -  Lactate dehydrogenase (LDH).         Tumor marker levels are measured again, after inguinal orchiectomy and biopsy, in order to determine the stage of the cancer. This helps to show if all of the cancer has been removed or if more treatment is needed. Tumor marker levels are also measured during follow-up as a way of checking if the cancer has come back.
                
                
                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
                
                
                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if testicular cancer spreads to the lung, the cancer cells in the lung are actually testicular cancer cells. The disease is metastatic testicular cancer, not lung cancer.
                
                
                    The following stages are used for testicular cancer:
                    Stage 0 (Testicular Intraepithelial Neoplasia)    In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called testicular intraepithelial neoplasia and testicular intratubular germ cell neoplasia.        Stage I    In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after an inguinal orchiectomy is done.            - In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.     - In stage IB, cancer:                   -  is in the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle; or       - has spread to the outer layer of the membrane surrounding the testicle; or       - is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle.           All tumor marker levels are normal.     - In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:                  - all tumor marker levels are slightly above normal; or       - one or more tumor marker levels are moderately above normal or high.                          Stage II     Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after an inguinal orchiectomy is done.            - In stage IIA, cancer:                   - is anywhere within the testicle, spermatic cord, or scrotum; and       - has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.           All tumor marker levels are normal or slightly above normal.     - In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:                  - has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or       - has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.           All tumor marker levels are normal or slightly above normal.     - In stage IIC, cancer:                  - is anywhere within the testicle, spermatic cord, or scrotum; and       - has spread to a lymph node in the abdomen that is larger than 5 centimeters.           All tumor marker levels are normal or slightly above normal.              Stage III     Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after an inguinal orchiectomy is done.            - In stage IIIA, cancer:                  - is anywhere within the testicle, spermatic cord, or scrotum; and       - may have spread to one or more lymph nodes in the abdomen; and       - has spread to distant lymph nodes or to the lungs.            Tumor marker levels may range from normal to slightly above normal.     - In stage IIIB, cancer:                  - is anywhere within the testicle, spermatic cord, or scrotum; and       - may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.           The level of one or more tumor markers is moderately above normal.     - In stage IIIC, cancer:                  - is anywhere within the testicle, spermatic cord, or scrotum; and       - may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.            The level of one or more tumor markers is high. or Cancer:                  - is anywhere within the testicle, spermatic cord, or scrotum; and       - may have spread to one or more lymph nodes in the abdomen; and       - has not spread to distant lymph nodes or the lung but has spread to other parts of the body.           Tumor marker levels may range from normal to high.