From the Guidelines
Testicular cancer that has spread to the lymph nodes is classified as stage 2 (II). This classification is based on the tumor, nodes, and metastases (TNM) staging system used by the American Joint Committee on Cancer, as mentioned in the study by 1. The cancer has moved beyond the testicle but remains confined to the lymph nodes in the retroperitoneum.
Key Points to Consider
- Stage 2 is further subdivided into stages 2A, 2B, and 2C, depending on the size and number of affected lymph nodes, with stage 2A having lymph nodes smaller than 2 cm, stage 2B having lymph nodes between 2-5 cm, and stage 2C having at least one lymph node larger than 5 cm.
- Treatment typically involves orchiectomy (surgical removal of the affected testicle) followed by either retroperitoneal lymph node dissection, chemotherapy, or radiation therapy, depending on the cancer type and substage, as outlined in the 2021 National Comprehensive Cancer Network (NCCN) guidelines referenced in 1.
- The 5-year survival rate for stage 2 testicular cancer is generally very good, ranging from 90-95%, as this cancer type responds well to treatment even after it has spread to lymph nodes, according to 1.
- Regular follow-up care is essential after treatment to monitor for potential recurrence, with the NCCN guidelines recommending imaging surveillance to detect relapse for 5 years after orchiectomy, as stated in 1.
Clinical Implications
The management of testicular cancer that has spread to the lymph nodes (stage 2) involves a multidisciplinary approach, including surgery, chemotherapy, and radiation therapy. The choice of treatment depends on the subtype of testicular cancer (seminoma or non-seminoma) and the extent of lymph node involvement, as discussed in 1. Given the excellent prognosis of testicular cancer, even when it has spread to the lymph nodes, early detection and timely treatment are crucial to achieve the best possible outcomes, as emphasized by the high survival rates mentioned in 1.
From the Research
Testicular Cancer Staging
When testicular cancer has spread to the lymph nodes, it is typically considered to be at a more advanced stage. The staging of testicular cancer is as follows:
- Stage I: The cancer is limited to the testis and has not spread to other parts of the body.
- Stage II: The cancer has spread to the retroperitoneal lymph nodes, which are located in the abdomen.
- Stage III: The cancer has spread to other parts of the body, such as the lungs, liver, or brain.
Lymph Node Involvement
If the cancer has spread to the lymph nodes, it would be classified as Stage II or higher, depending on the extent of the spread. According to the study 2, retroperitoneal lymph node dissection (RPLND) is a treatment option for patients with clinical stage I nonseminomatous germ cell tumors of the testis, but it may not be sufficient to prevent recurrence if the cancer has already spread to the lymph nodes.
Treatment Options
Treatment options for testicular cancer that has spread to the lymph nodes may include:
- Chemotherapy: Such as bleomycin, etoposide, and cisplatin (BEP) chemotherapy, which has been shown to be effective in reducing the risk of recurrence 3, 2.
- Retroperitoneal lymph node dissection (RPLND): This is a surgical procedure that involves removing the lymph nodes in the abdomen to prevent the spread of cancer.
- Radiation therapy: This may be used in combination with chemotherapy or surgery to treat testicular cancer that has spread to the lymph nodes.
Prognosis
The prognosis for testicular cancer that has spread to the lymph nodes depends on various factors, including the stage of the cancer, the type of cancer, and the effectiveness of treatment. According to the study 4, the median survival for patients with testicular lymphoma is 29 months, and the survival rate is significantly better for patients with early-stage disease.