Testicular Cancer

Question 1

A 45-year-old male patient is diagnosed with a testicular tumor. A radical orchiectomy is performed. The pathology report shows that the tumor was limited to the testis and epididymis, with vascular/lymphatic invasion. How would the primary tumor be staged according to the TNM staging system?

Multiple-Choice Options:
A. pT0
B. pT1
C. pT2
D. pT3

Answer 1

Correct Answer:
C. pT2

Explanation for Each Answer:

A. pT0: Incorrect. pT0 indicates no evidence of a primary tumor, not applicable here.
B. pT1: Incorrect. pT1 refers to tumors limited to the testis and epididymis without vascular/lymphatic invasion.
C. pT2: Correct. The tumor is limited to the testis and epididymis but has vascular/lymphatic invasion.
D. pT3: Incorrect. pT3 indicates that the tumor invades the spermatic cord, which is not the case here.
Memory Tool:
Remember the “2V rule”: pT2 has “Two factors” - Tumor limited to the testis and epididymis, and Vascular invasion.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: PRIMARY TUMOR (T)a - pT2

Rationale:
Understanding TNM staging is crucial for appropriate treatment planning and prognostication in testicular cancer. This question tests your knowledge about the importance of vascular/lymphatic invasion in TNM staging.

Question 2

Clinical Vignette:
A patient has a testicular tumor and undergoes an RPLND without prior chemotherapy or radiotherapy. The pathology reveals metastasis with a lymph node mass >2 cm but not more than 5 cm. How would the regional lymph node involvement be staged?

Multiple-Choice Options:
A. pN0
B. pN1
C. pN2
D. pN3

Answer 2

Correct Answer:
C. pN2

Explanation for Each Answer:

A. pN0: Incorrect. This indicates no regional lymph node metastasis.
B. pN1: Incorrect. Metastasis in this stage has lymph node mass ≤2 cm.
C. pN2: Correct. The pathology showed lymph node mass >2 cm but not more than 5 cm.
D. pN3: Incorrect. This stage indicates a lymph node mass >5 cm.
Memory Tool:
Think of the numbers as thresholds for size: pN1 (≤2 cm), pN2 (>2 & ≤5 cm), pN3 (>5 cm).

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: Pathologic (pN) - pN2

Rationale:
Staging regional lymph node involvement accurately is pivotal for assessing the extent of disease and guiding subsequent treatment. This question aims to test your understanding of lymph node size in testicular cancer staging.

Question 3

Question 3: Serum Tumor Markers in Testicular Cancer
Clinical Vignette:
A 28-year-old male patient has been diagnosed with testicular cancer. His serum tumor marker study levels are: LDH = 2×N, HCG (MIU/mL) = 6000, AFP (ng/mL) = 500. What would his serum tumor marker stage be according to the TNM staging?

Multiple-Choice Options:
A. S0
B. S1
C. S2
D. S3

Answer 3

Correct Answer:
C. S2

Explanation for Each Answer:

A. S0: Incorrect. This would indicate marker levels within normal limits, which isn’t the case here.
B. S1: Incorrect. The patient’s HCG and LDH levels are above the thresholds set for S1.
C. S2: Correct. The patient’s LDH, HCG, and AFP levels fall within the S2 criteria.
D. S3: Incorrect. S3 would involve considerably higher levels for each marker.
Memory Tool:
“S2 Soars Higher”: S2 has higher levels than S1, but not sky-high like S3.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: SERUM TUMOR MARKERS (S) - S2

Rationale:
Knowing how to interpret serum tumor markers is essential for accurate staging and consequently, the management plan. This question assesses your understanding of how different levels of serum markers contribute to staging.

Question 4

Clinical Vignette:
A 36-year-old male has a testicular tumor with confirmed metastasis to a nonregional lymph node but no evidence of pulmonary metastasis. According to the TNM system, what would be his distant metastasis stage?

Multiple-Choice Options:
A. M0
B. M1
C. M1a
D. M1b

Answer 4

Correct Answer:
C. M1a

Explanation for Each Answer:

A. M0: Incorrect. M0 indicates no distant metastasis, which is not the case here.
B. M1: Incorrect. While this is a broader category, it does not specify the details of metastasis.
C. M1a: Correct. Nonregional nodal metastasis without pulmonary involvement falls under M1a.
D. M1b: Incorrect. M1b involves distant metastasis to sites other than nonregional lymph nodes or lungs.
Memory Tool:
“M1a = Away but not Airborne”: Nonregional nodal but not pulmonary (air-related) metastasis.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: DISTANT METASTASIS (M) - M1a

Rationale:
The categorization of distant metastasis in testicular cancer has clinical implications for treatment selection. This question evaluates your understanding of specific distant metastasis classifications.

Question 5

Clinical Vignette:
A patient has been diagnosed with testicular cancer. He has a primary tumor that is limited to the testis and epididymis with vascular/lymphatic invasion (pT2), no regional lymph node metastasis (N0), and no distant metastasis (M0). His serum tumor marker studies are within normal limits (S0). What would be his TNM stage grouping?

Multiple-Choice Options:
A. Stage 0
B. Stage IA
C. Stage IB
D. Stage IS

Answer 5

Correct Answer:
C. Stage IB

Explanation for Each Answer:

A. Stage 0: Incorrect. Stage 0 refers to carcinoma in situ (pTis), N0, M0, and S0, which is not the case here.
B. Stage IA: Incorrect. Stage IA is specifically for pT1 tumors with N0, M0, and S0.
C. Stage IB: Correct. This stage includes pT2, N0, M0, and S0 which fits the patient’s clinical picture.
D. Stage IS: Incorrect. Stage IS involves any pT or pTx, N0, M0, and S1-3, not applicable for this case.
Memory Tool:
“Stage IB = pT2 & All Clear Elsewhere”: pT2 with N0, M0, and S0 signifies Stage IB.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: STAGE GROUPING - Stage IB

Rationale:
Understanding the TNM stage grouping is essential for treatment planning and prognostication. This question tests your comprehension of how individual TNM components combine into a stage grouping.

Question 6

Clinical Vignette:
A 40-year-old man underwent a retroperitoneal lymph node dissection without prior chemotherapy or radiotherapy. The pathology report showed metastasis with a lymph node mass of 3 cm and extranodal extension of the tumor. What is the pathologic (pN) staging?

Multiple-Choice Options:
A. pN0
B. pN1
C. pN2
D. pN3

Answer 6

Multiple-Choice Options:
A. pN0
B. pN1
C. pN2
D. pN3

Correct Answer:
C. pN2

Explanation for Each Answer:

A. pN0: Incorrect. There is evidence of lymph node involvement.
B. pN1: Incorrect. The lymph node mass is greater than 2 cm.
C. pN2: Correct. The lymph node mass is greater than 2 cm but not more than 5 cm, with evidence of extranodal extension.
D. pN3: Incorrect. The lymph node mass is not greater than 5 cm.

Question 7

Clinical Vignette:
A 50-year-old man is diagnosed with testicular cancer. His lactate dehydrogenase (LDH) level is 6 times the upper limit of normal, HCG is 20,000 MIU/mL, and AFP is 900 ng/mL. What would be the categorization of his serum tumor markers?

Multiple-Choice Options:
A. S0
B. S1
C. S2
D. S3

Answer 7

Correct Answer:
D. S3

Explanation for Each Answer:

A. S0: Incorrect. Serum marker levels are not within normal limits.
B. S1: Incorrect. Each of the markers exceeds the specified range for S1.
C. S2: Incorrect. HCG and LDH levels exceed the S2 range.
D. S3: Correct. His LDH is >10x N, HCG >50,000 MIU/mL, and AFP is above the limits for S1 and S2, fitting the criteria for S3.
Memory Tool:
“Serum 3: All Above” - S3 indicates that all serum markers are way above the normal or slightly elevated range.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: SERUM TUMOR MARKERS - S3

Rationale:
Understanding serum marker categories is crucial for assessing the extent and prognosis of testicular cancer. This question examines your grasp of serum marker levels.

Question 8

Clinical Vignette:
A patient with testicular cancer has confirmed metastasis to the liver. What would be his distant metastasis (M) categorization?

Multiple-Choice Options:
A. M0
B. M1
C. M1a
D. M1b

Answer 8

Correct Answer:
D. M1b

Explanation for Each Answer:

A. M0: Incorrect. The patient has distant metastasis.
B. M1: Incorrect. This is a general category; more specifics are needed.
C. M1a: Incorrect. This involves nonregional nodal or pulmonary metastasis only.
D. M1b: Correct. Metastasis at a site other than nonregional lymph nodes or lung fits this category.
Memory Tool:
“Met to Liver, Mark it B” - Distant metastasis to the liver falls under M1b.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: DISTANT METASTASIS - M1b

Rationale:
The ability to categorize distant metastasis is integral for staging and thus managing testicular cancer effectively. The question evaluates your ability to do so based on clinical information.

Question 9

Clinical Vignette:
A 35-year-old man is diagnosed with testicular cancer. His tumor is limited to the testis with vascular invasion (pT2), no lymph node metastasis (N0), no distant metastasis (M0), and his serum markers are within normal limits (S0). What would be his stage grouping?

Multiple-Choice Options:
A. Stage IA
B. Stage IB
C. Stage IS
D. Stage IIA

Answer 9

Correct Answer:
B. Stage IB

Explanation for Each Answer:

A. Stage IA: Incorrect. pT1 tumors with no vascular invasion fall under this category.
B. Stage IB: Correct. The tumor (pT2) is limited to the testis with vascular invasion, fitting this stage.
C. Stage IS: Incorrect. This is for cases with abnormal serum markers but localized tumors.
D. Stage IIA: Incorrect. This would require at least N1 lymph node involvement.
Memory Tool:
“Vascular Invasion Brings you to IB” - pT2 with vascular invasion takes the staging to IB.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: Stage IB

Rationale:
Stage grouping is critical in determining treatment plans and prognosis. This question tests your ability to integrate various aspects of TNM staging into a unified stage group.

Question 10

Clinical Vignette:
A man diagnosed with testicular cancer has a tumor that extends through the tunica albuginea with involvement of tunica vaginalis (pT2), metastasis in multiple lymph nodes none more than 5cm (N2), and lung metastasis (M1a). His serum LDH levels are 8 times the normal limit. What would be his stage grouping?

Multiple-Choice Options:
A. Stage IIB
B. Stage IIIA
C. Stage IIIB
D. Stage IIIC

Answer 10

Correct Answer:
C. Stage IIIB

Explanation for Each Answer:

A. Stage IIB: Incorrect. This stage does not account for the distant metastasis.
B. Stage IIIA: Incorrect. Serum marker levels are not within normal limits.
C. Stage IIIB: Correct. His status meets the criteria of N1-3, M1a, and elevated serum markers (S2).
D. Stage IIIC: Incorrect. This would require even higher levels of serum markers (S3).
Memory Tool:
“Three B’s - Beyond, Big nodes, and Breath (lungs)” - Stage IIIB involves more complex cases.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: Stage IIIB

Rationale:
Understanding advanced stage groupings like Stage III is essential for aggressive treatment planning. This question pushes your comprehension of more complex cases.

Question 11

Clinical Vignette:
A patient has undergone radical orchiectomy for a suspected testicular tumor, but post-surgical histology shows no evidence of a primary tumor. What is the pathological stage of the primary tumor?

Multiple-Choice Options:
A. pTis
B. pT0
C. pT1
D. pTx

Answer 11

Correct Answer:
B. pT0

Explanation for Each Answer:

A. pTis: Incorrect. Intratubular germ cell neoplasia would be present for this stage.
B. pT0: Correct. This stage indicates no evidence of a primary tumor post-radical orchiectomy.
C. pT1: Incorrect. This would indicate a tumor limited to the testis and epididymis without vascular invasion.
D. pTx: Incorrect. This stage indicates that the primary tumor cannot be assessed.
Memory Tool:
“Zero Tumor, Zero stage” - pT0 means no evidence of a primary tumor.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: pT0

Rationale:
The pathological stage post-radical orchiectomy is crucial for treatment planning. This question clarifies the pT0 stage to improve your diagnostic accuracy.

Question 12

Clinical Vignette:
A 45-year-old male undergoes retroperitoneal lymph node dissection for staging of his testicular cancer. Pathology shows metastasis in six lymph nodes, the largest being 4 cm. What is the pathologic lymph node stage?

Multiple-Choice Options:
A. pN1
B. pN2
C. pN3
D. pNX

Answer 12

Correct Answer:
B. pN2

Explanation for Each Answer:

A. pN1: Incorrect. The number of positive nodes exceeds five, and the largest is more than 2 cm.
B. pN2: Correct. Metastasis in more than five nodes and largest node size between 2-5 cm fit this stage.
C. pN3: Incorrect. The largest node is not greater than 5 cm.
D. pNX: Incorrect. This stage is when regional lymph nodes cannot be assessed.
Memory Tool:
“Six Nodes, Second stage” - six nodes with sizes up to 4 cm corresponds to pN2.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: pN2

Rationale:
This question tests your ability to interpret pathological findings, essential for advanced stage cancer planning.

Question 13

Clinical Vignette:
A patient with a recent diagnosis of testicular cancer has marker study levels within the normal limits. What is the serum tumor marker stage?

Multiple-Choice Options:
A. S0
B. S1
C. S2
D. SX

Answer 13

Correct Answer:
A. S0

Explanation for Each Answer:

A. S0: Correct. Marker study levels within normal limits are classified as S0.
B. S1: Incorrect. Elevated markers would be required for this stage.
C. S2: Incorrect. Significantly elevated markers would be needed.
D. SX: Incorrect. This is when marker studies are unavailable or not performed.
Memory Tool:
“Serum Zero, Stage Zero” - Normal serum markers correspond to S0.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: S0

Rationale:
Serum tumor markers are essential for both diagnosis and monitoring response to therapy. This question clarifies the S0 stage.

Question 14

Clinical Vignette:
A patient undergoes retroperitoneal lymph node dissection after being diagnosed with testicular cancer. Pathology reports show a lymph node mass greater than 5 cm in greatest dimension. What is the pathologic (pN) stage for regional lymph nodes?

Multiple-Choice Options:
A. pN0
B. pN1
C. pN2
D. pN3

Answer 14

Correct Answer:
D. pN3

Explanation for Each Answer:

A. pN0: Incorrect. This indicates no regional lymph node metastasis.
B. pN1: Incorrect. This stage is for a lymph node mass ≤2 cm and ≤5 nodes positive, none more than 2 cm.
C. pN2: Incorrect. This stage includes lymph node mass >2 cm but not more than 5 cm.
D. pN3: Correct. This stage is for metastasis with a lymph node mass greater than 5 cm in greatest dimension.
Memory Tool:
“Node Needing 3: Node over 5 cm” - Lymph node mass over 5 cm corresponds to pN3.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: pN3

Rationale:
Correct staging of lymph nodes post-RPLND is critical for prognosis and treatment planning.

Question 15

Clinical Vignette:
A 40-year-old male has a tumor limited to testis and epididymis without vascular/lymphatic invasion. Serum tumor markers are within normal limits, and no regional lymph node metastasis is detected. What stage grouping would he fall under?

Multiple-Choice Options:
A. Stage I
B. Stage IA
C. Stage IB
D. Stage IS

Answer 15

Correct Answer:
B. Stage IA

Explanation for Each Answer:

A. Stage I: Incorrect. While it’s true he would fall under Stage I, the question asks for the most specific stage grouping.
B. Stage IA: Correct. This stage includes pT1, N0, M0, and S0.
C. Stage IB: Incorrect. This would require a tumor extending through the tunica albuginea with involvement of the tunica vaginalis.
D. Stage IS: Incorrect. This stage would involve abnormal serum markers, which is not the case here.
Memory Tool:
“IA: It’s Absolutely simple” - All factors are at their simplest (pT1, N0, M0, S0).

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: Stage IA

Rationale:
A thorough understanding of stage grouping is important for predicting outcomes and tailoring treatment plans.

Question 16

Clinical Vignette:
A 30-year-old male presents with testicular cancer and undergoes tests for serum tumor markers. The results show AFP levels at 1500 ng/mL, LDH at 2×N, and HCG at 7000 MIU/mL. What would the serum tumor marker stage be?

Multiple-Choice Options:
A. S0
B. S1
C. S2
D. S3

Answer 16

Correct Answer:
D. S3

Explanation for Each Answer:

A. S0: Incorrect. This stage indicates marker levels within normal limits.
B. S1: Incorrect. Levels are above the threshold for S1.
C. S2: Incorrect. Although one or two markers are in this range, the AFP level of 1500 ng/mL pushes it to S3.
D. S3: Correct. HCG > 50,000 or AFP > 10,000 or LDH > 10×N. Here, AFP is 1500 ng/mL which is above the S2 cut-off but less than S3. However, HCG at 7000 MIU/mL pushes the staging to S3.
Memory Tool:
“S3: Super Serious Situation” - Extremely high levels of any marker push it to S3.

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: S3

Rationale:
Knowing the serum marker stage helps in prognosis and can guide further treatment decisions.

Question 17

Clinical Vignette:
A 55-year-old male has a testicular tumor that invades the scrotum, but without any vascular/lymphatic invasion. What is the pT stage?

Multiple-Choice Options:
A. pT1
B. pT2
C. pT3
D. pT4

Answer 17

Correct Answer:
D. pT4

Explanation for Each Answer:

A. pT1: Incorrect. Tumor is not limited to just the testis and epididymis.
B. pT2: Incorrect. Again, not just limited to testis and epididymis.
C. pT3: Incorrect. This would involve invasion of the spermatic cord.
D. pT4: Correct. The tumor invades the scrotum, making it a pT4.
Memory Tool:
“pT4: Takes 4 steps to go beyond the cord and reach the scrotum.”

Reference Citation:
Data from AJCC: Testis. In Edge SE, Byrd DR, Compton CC, editors: AJCC Cancer Staging Manual, ed 7, New York, 2010, Springer, pp 469–473. Paragraph: pT4

Rationale:
Proper classification of the primary tumor is crucial for management and surgical planning.

Question 18

Question 1: Primary Tumor Classification
Topic: TNM Staging - Primary Tumor (T) Classification

A 32-year-old male undergoes radical orchiectomy. The pathology report reveals a tumor limited to the testis and epididymis without vascular or lymphatic invasion. What is the primary tumor stage?

A) pT0
B) pT1
C) pTis
D) pT2

Answer 18

Correct Answer: B) pT1
Explanation:

A) pT0: No evidence of primary tumor. Incorrect.
B) pT1: Tumor limited to testis and epididymis without vascular/lymphatic invasion. Correct.
C) pTis: Intratubular germ cell neoplasia. Incorrect.
D) pT2: Tumor limited to testis and epididymis but with vascular/lymphatic invasion. Incorrect.
Memory Tool: “PT1: Test-1-s and epididymis, no invasion.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: This question is vital because understanding the primary tumor staging helps guide treatment and prognosis.

Question 19

Topic: TNM Staging - Regional Lymph Nodes (N) Clinical

A male patient has multiple lymph nodes involved with none more than 2 cm in greatest dimension. What is the clinical N stage?

A) N0
B) N1
C) N2
D) N3

Answer 19

Correct Answer: B) N1
Explanation:

A) N0: No regional lymph node metastasis. Incorrect.
B) N1: Metastasis with lymph node mass ≤2 cm and multiple lymph nodes, none more than 2 cm. Correct.
C) N2: Metastasis with lymph node mass >2 cm but not more than 5 cm. Incorrect.
D) N3: Metastasis with lymph node mass >5 cm. Incorrect.
Memory Tool: “N1: Nodes are Number one, but none more than 2 cm.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: Accurate nodal staging is essential for treatment planning and prognosis.

Question 20

Topic: TNM Staging - Distant Metastasis (M)

Which distant metastasis stage corresponds to nonregional nodal or pulmonary metastasis?

A) M0
B) M1
C) M1a
D) M1b

Answer 20

Correct Answer: C) M1a
Explanation:

A) M0: No distant metastasis. Incorrect.
B) M1: Distant metastasis present, but unspecified. Incorrect.
C) M1a: Nonregional nodal or pulmonary metastasis. Correct.
D) M1b: Distant metastasis at site other than nonregional lymph nodes or lung. Incorrect.
Memory Tool: “M1a: First A-class ticket to nonregional or lung.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: Knowing distant metastasis categories guides systemic therapy.

Question 21

Topic: TNM Staging - Serum Tumor Markers (S)

A patient has the following lab results: LDH = 1.3 × Nb, HCG (MIU/mL) = 4000, AFP (ng/mL) = 800. What is the Serum Tumor Marker stage?

A) S0
B) S1
C) S2
D) S3

Answer 21

Correct Answer: B) S1
Explanation:

A) S0: Marker study levels within normal limits. Incorrect.
B) S1: LDH <1.5 × Nb and HCG (MIU/mL) <5000 and AFP (ng/mL) <1000. Correct.
C) S2: LDH 1.5-10 × N or HCG (MIU/mL) 5000–50,000 or AFP (ng/mL) 1000–10,000. Incorrect.
D) S3: LDH >10 × N or HCG (MIU/mL) >50,000 or AFP (ng/mL) >10,000. Incorrect.
Memory Tool: “S1: Serum Sweet-spot—just under the limits.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: Serum Tumor Marker staging impacts management, specifically regarding the need for chemotherapy or surveillance.

Question 22

Topic: TNM Staging - Stage Grouping

A patient has a pT3 primary tumor, N0 lymph nodes, M0 distant metastasis, and S0 Serum Tumor Markers. What is the patient’s stage grouping?

A) Stage IA
B) Stage IB
C) Stage IIA
D) Stage IIB

Answer 22

Correct Answer: B) Stage IB
Explanation:

A) Stage IA: pT1, N0, M0, S0. Incorrect.
B) Stage IB: pT2, N0, M0, S0 or pT3, N0, M0, S0 or pT4, N0, M0, S0. Correct.
C) Stage IIA: Any pT/Tx, N1, M0, S0. Incorrect.
D) Stage IIB: Any pT/Tx, N2, M0, S0. Incorrect.
Memory Tool: “Stage IB: I Before Stage II, meaning no nodal or distant spread but with higher primary tumor stage.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: Stage grouping combines T, N, M, and S factors to provide a comprehensive outlook on patient prognosis and management.

Question 23

What is the difference between clinical (N) and pathologic (pN) staging of regional lymph nodes in Table 76.2?

A) Pathologic staging includes lymph node mass size
B) Clinical staging is determined by noninvasive staging
C) Pathologic staging includes extranodal extension of the tumor
D) Clinical staging includes the impact of prior chemotherapy or radiotherapy

Answer 23

Correct Answer: C) Pathologic staging includes extranodal extension of the tumor
Explanation:

A) Incorrect: Both clinical and pathologic staging include lymph node mass size.
B) Correct but not the best answer: Clinical staging is indeed determined by noninvasive methods, but this doesn’t differentiate it from pathologic staging in the table.
C) Correct: Pathologic staging mentions ‘evidence of extranodal extension of tumor’ under pN2.
D) Incorrect: Clinical staging doesn’t include the impact of prior chemotherapy or radiotherapy; it is determined by noninvasive staging.
Memory Tool: “Clinical Cares about size, Pathologic Peeks at extranodal action.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: Understanding the nuances between clinical and pathologic staging is key for accurate diagnosis and treatment planning.

Question 24

Which of the following is categorized under M1a for distant metastasis according to Table 76.2?

A) Regional lymph node metastasis
B) Pulmonary metastasis
C) Extraregional lymph node metastasis
D) Liver metastasis

Answer 24

Correct Answer: B) Pulmonary metastasis
Explanation:

A) Incorrect: Regional lymph node metastasis would be categorized under N, not M.
B) Correct: M1a includes nonregional nodal or pulmonary metastasis.
C) Incorrect: This is also included in M1a but not the only criterion.
D) Incorrect: Liver metastasis would be categorized as M1b.
Memory Tool: “M1a: Airway Alert—think pulmonary.”
Reference Citation: Table 76.2, AJCC Cancer Staging Manual, ed 7, 2010, Springer.
Rationale: Identifying the specific sites of distant metastasis aids in treatment selection and prognosis.