Last updated: 08-Oct-2026
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Three results set the stage together: the tumour type, the CT scan, and the AFP, hCG and LDH levels after the testis is out.
Stage I usually means close surveillance instead of more treatment. Spread to lymph nodes or beyond brings chemotherapy, surgery, or both.
For spread disease, the IGCCCG risk group fixes the chemotherapy: usually three BEP cycles in the good group, four in intermediate or poor.
After the testis is removed through the groin, three results together set the stage:
The order of these tests, and why the markers must be taken before the operation as well, is explained in testicular cancer tests in order. This page starts where that one ends: the results are in, and the question is what they mean.
| Stage | What it means | Usual path |
|---|---|---|
| Stage I | Cancer confined to the testis; markers back to normal after surgery | Surveillance in most men; a single preventive treatment in some |
| Stage IIA | Lymph nodes at the back of the abdomen, up to 2 cm | Smaller, targeted options in selected men, or chemotherapy |
| Stage IIB | Lymph nodes 2 to 5 cm | Smaller, targeted options in selected men, or chemotherapy |
| Stage IIC | Lymph nodes larger than 5 cm | Cisplatin-based chemotherapy, with surgery after it if a mass remains |
| Stage III | Spread beyond these nodes, such as to the lungs or other organs | Cisplatin-based chemotherapy by risk group, with surgery after it if a mass remains |
This cancer usually responds well to treatment, even after it has spread. So the aim at every stage is the treatment the stage needs: not less, out of caution, and not more for a man who will do well with surveillance.
For stage I seminoma, surveillance is the recommended path. No further treatment is given; instead, regular markers and scans watch for any return, which is then treated.
Two features in the pathology report raise the chance of return: a tumour larger than 4 cm, and spread into the rete testis (the channels at the back of the testis). When either is present, one cycle of carboplatin is discussed as an alternative. Without them, extra treatment adds no real benefit.
Radiotherapy after the operation, once common, is now generally not advised for stage I seminoma, because of the risk of a new cancer in the treated area.
Surveillance only works if you can attend. If distance, travel for work or no phone will make visits hard, the single dose of carboplatin is discussed openly instead. The visit schedule is set out in testicular cancer follow-up.
For most men with stage I non-seminoma, surveillance is again the preferred path.
The feature that matters most is lymphovascular invasion (LVI): cancer cells seen inside small blood or lymph vessels in the removed testis. It raises the chance of return considerably. One cycle of BEP chemotherapy after the operation lowers that chance, and is discussed when LVI is present.
An operation to remove the lymph nodes at the back of the abdomen (RPLND) is used in selected stage I cases: for example, a teratoma with a non-germ-cell cancer growing inside it, or a man who cannot attend surveillance and does not want chemotherapy.
When lymph nodes are involved but not large, full chemotherapy is not the only route.
For seminoma with normal markers and nodes up to 3 cm, a nerve-sparing RPLND is now an accepted option. Focused radiotherapy with one cycle of carboplatin is another, in selected men. Otherwise, chemotherapy is given.
Nerve-sparing means the nerves that control ejaculation are kept wherever the cancer allows. Whether they could be kept is told to you in person after the operation.
Once the cancer has spread further, chemotherapy with BEP (bleomycin, etoposide, cisplatin) is the main treatment. The international risk grouping (IGCCCG) decides how many cycles:
| Risk group | Seminoma | Non-seminoma | Usual chemotherapy |
|---|---|---|---|
| Good | Any marker level; no spread to organs other than the lungs | Primary in the testis or behind the abdomen; no spread to organs other than the lungs; low markers | Three cycles of BEP, or four of EP when bleomycin is not suitable |
| Intermediate | Spread to organs other than the lungs | Intermediate marker levels | Four cycles of BEP |
| Poor | Does not exist for seminoma | Primary in the chest (mediastinum), spread to organs other than the lungs, or high markers | Four cycles of BEP |
One recent change matters for seminoma. In the good group, an LDH more than 2.5 times the upper limit of normal behaves like the intermediate group, so most of these men are given four cycles rather than three.
The cycles are given on time. Doses are not cut or delayed for low blood counts without support to raise them, because keeping to the schedule is part of what makes the treatment work.
A scan after chemotherapy may still show a lump in the abdomen. What happens next depends on the type:
Surgery after chemotherapy is a major operation. The details are on surgery, sperm banking and nerve-sparing RPLND.
Some things are the same for every man, whatever his stage or group:
Reports can be sent ahead, so the consultation starts with them already read. Treatment is decided at the consultation, after examination.
The value after surgery. The earlier one is the starting point; the stage and the risk group use the marker levels once the testis has been removed.
In the international grouping, seminoma is placed only in the good or intermediate group. Spread to organs other than the lungs moves it to intermediate.
Usually no further treatment is given, but surveillance is itself the treatment: regular markers and scans, kept on schedule, so any return is found early.
Not usually in stage I. RPLND is used for a leftover mass after chemotherapy, in some small-node seminomas, and in selected stage I cases.
It is offered to every man, at every stage, before chemotherapy or RPLND. Stage does not decide it; your wishes do.
Testicular cancer as a whole is covered on the testicular cancer surgery page.
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Testicular Cancer Surgeon
Consultation at the Gota OPD, Ahmedabad. Surgery at Apollo Hospital, Bhat, Gandhinagar.
Gota OPD, Ahmedabad — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
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