When we talk about staging of testicular cancer, we are talking about the extent of spread of the cancer.
Although the cancer usually originates within the testicle, it has the ability to spread to other parts of the body. And testicular cancer spreads in a very predictable manner. It first spreads to the lymph nodes in the abdominal area. From there, it can be spread to the chest area. And from there, it can spread higher up to the brain.
So, the extent of spread of cancer determines the stage of your cancer. If you have cancer that is confined to the testicle, which means that you have undergone imaging, like CT imaging of the abdomen, that shows no evidence of disease in the abdomen, then you have what is called stage 1 testicular cancer.
In patients with stage 1 cancer, we then look at the type of cancer that you have. And we look at something called your testicular tumor marker status. Tumor markers are proteins that can be produced by testicular cancer. And when those markers are elevated, then that can give you a clue as to the type of cancer that you have.
Now, stage 1 testicular cancer may be treated differently depending on the type of cancer you have. If you have a seminoma, we know that seminomas respond well to radiation therapy. However, there can be some complicating factors. You may have a seminoma in your testicle and your tumor markers such as the AFP level may be elevated.
If your AFP is elevated, by definition, seminomas do not produce AFP and there has to be some component of a non-seminomitous germ cell tumor. So it can get very tricky. So if you have a stage 1 seminoma, but your AFP level is elevated, after the testes is removed, then chances are you would be treated as a non-seminomitous germ cell tumor.
And, if your tumor markers remain elevated then, that indicates that, even though the CT imaging shows no evidence of disease elsewhere, then microscopically you most likely have disease elsewhere. And those patients would then go on to have chemotherapy.
And there's always options. So it's important for you to ask your physician what are the options, what are the pros and cons of the various approaches and what can I expect with each of the approaches.