| Course | PA 512 CCM Hematology/Oncology |
|---|---|
| Week | 6 |
| Paper type | TNM staging worksheet |
| Length | About 510 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 512 Week 6
TNM Staging Worksheet: A Mixed Nonseminomatous Germ Cell Tumor of the Left Testis With Lymphovascular Invasion, a 3.8-Centimeter Para-Aortic Node and Markers Taken After Orchiectomy
Student Name
Chamberlain University
PA 512: CCM Hematology/Oncology
Instructor Name
Month Day, Year
TNM Staging Worksheet: A Mixed Nonseminomatous Germ Cell Tumor of the Left Testis With Lymphovascular Invasion, a 3.8-Centimeter Para-Aortic Node and Markers Taken After Orchiectomy
Scenario as Supplied
J.L., 31, found a firm left testicular lump while showering. Scrotal ultrasound showed a 3.4-centimeter solid mass in the left testis. Before surgery: alpha-fetoprotein (AFP) 1,480 ng/mL, human chorionic gonadotropin (hCG) 2,150 mIU/mL, lactate dehydrogenase (LDH) 310 U/L (upper limit of normal 250). Left radical inguinal orchiectomy on February 4. Pathology: mixed germ cell tumor, embryonal carcinoma 60%, yolk sac tumor 30%, teratoma 10%; 3.4 cm; confined to the testis; lymphovascular invasion present; spermatic cord margin negative. CT of chest, abdomen and pelvis on February 12: a 3.8-centimeter left para-aortic lymph node mass; no other enlarged nodes; lungs clear. Markers on February 14, ten days after orchiectomy: AFP 690 ng/mL, hCG 62 mIU/mL, LDH 275 U/L.
The Worksheet
Prefix: T is pathologic, from the orchiectomy specimen (pT). N and M are clinical, from imaging (cN, cM). The serum marker category (S) uses values after orchiectomy (American Joint Committee on Cancer, 2017).
Table 1
TNM and S Components for J.L., One Row per Component
| Component | Value | Source in the scenario |
|---|---|---|
| T | pT2 | Pathology: tumor confined to testis with lymphovascular invasion |
| N | cN2 | CT: single left para-aortic node mass 3.8 cm, more than 2 cm and not more than 5 cm |
| M | cM0 | CT chest: lungs clear; no nonregional nodes on CT |
| S | S1 | Post-orchiectomy markers: AFP 690 ng/mL (under 1,000), hCG 62 mIU/mL (under 5,000), LDH 275 U/L (under 1.5 times the upper limit) |
| Stage group | IIB | Any pT, N2, M0, S0 or S1 |
Note. Note. Categories follow the AJCC eighth edition for testicular cancer.
Unassessed Is Not Zero
No brain imaging was done. That is appropriate for this presentation, and it does not change cM0, which rests on what was imaged. If the chest CT had not been done, M would have been unassessable rather than M0, and the worksheet would have said so. Writing a zero for something nobody looked at would claim a negative finding that does not exist.
Why S Uses the Later Markers
The pre-orchiectomy AFP of 1,480 ng/mL would have placed J.L. in S2. Staging uses the values after the tumor in the testis is removed, because those reflect remaining disease. Markers clear at known rates, so a value taken too early can overstate S (Gilligan et al., 2010). At ten days, hCG has had several half-lives to fall; AFP, which clears more slowly, has had fewer, and its plateau is followed next week.
Reading the Group
Stage IIB: disease spread to retroperitoneal nodes, without distant spread, and with marker levels in the lowest elevated category. The worksheet does not go on to risk classification or treatment, which are separate decisions.
References
American Joint Committee on Cancer. (2017). AJCC cancer staging manual (8th ed.). Springer.
Gilligan, T. D., Seidenfeld, J., Basch, E. M., Einhorn, L. H., Fancher, T., Smith, D. C., Stephenson, A. J., Vaughn, D. J., Cosby, R., & Hayes, D. F. (2010). American Society of Clinical Oncology clinical practice guideline on uses of serum tumor markers in adult males with germ cell tumors. Journal of Clinical Oncology, 28(20), 3388-3404. https://doi.org/10.1200/JCO.2009.26.4481
PA 512 Week 6 instructions, in plain terms
The sixth week asks for a staging worksheet built from a scenario your section supplies. Give one row per component, with the value assigned and the sentence or finding in the scenario that supports it. State the prefix clearly, since a worksheet built on clinical information differs from one built on pathology, and some cancers combine both. Use the unassessed marker only where nothing was examined, and never write zero for a component nobody looked at. Where the cancer has an additional category, such as serum markers in testicular cancer, include it with its timing rule. Read the stage group from the rows and cite the staging manual. Keep grade, histology and risk groups separate from the staging rows unless the system uses them, and do not go on to treatment.
Inside the PA 512 Week 6 example
The scenario gives a 3.4-centimeter mass found while showering, pre-orchiectomy markers of AFP 1,480, hCG 2,150 and LDH 310, pathology showing a mixed tumor with lymphovascular invasion confined to the testis, a CT with a 3.8-centimeter left para-aortic node and clear lungs, and markers ten days after surgery of AFP 690, hCG 62 and LDH 275. The worksheet states that T is pathologic and N and M clinical, and that S uses post-orchiectomy values. Its table gives pT2, cN2, cM0, S1 and stage IIB, each with its source. A section explains that brain imaging was not needed and how an undone chest CT would have been recorded. Another explains that the earlier AFP would have meant S2 and why the later value is used, with the marker half-lives. The close reads the group and stops before risk classification and treatment.
Where the points sit in the PA 512 Week 6 rubric
The worst error is the unassessed marker used where the scenario reported a component, or a zero written where nothing was examined, because those entries say opposite things and a reader cannot tell which was meant. A component entered with no source beside it follows: the value may be right and still cannot be marked. Further deductions come from no stated prefix, from grade or histology entered as if it were a staging component, from the serum marker category taken from pre-surgical values and from a stage group that does not follow from the rows. Smaller losses go to worksheets that drift into treatment. Full credit goes to one row per component with value and source, a stated prefix, a correct timing rule for markers, unassessed used only where nothing was examined and a stage group read straight from the rows, with the manual cited.
PA 512 Week 6 help: mistakes that cost points
Staging worksheets are short, but each row is checked against the scenario, so a missing source costs as much as a wrong value. With the scenario from your section, we can work through each component, write the supporting finding beside it and choose the right prefix. Telling unassessed from negative, and stating it in the row, is a distinction worth getting exactly right. For cancers with marker categories or other extra rules, we can help you apply the timing correctly and explain it in a sentence. The values and the stage group are yours. If your assignment is a restaging worksheet after treatment, the custom sample uses the correct prefix for that setting and explains how it differs.
Get a PA-512 Week 6 example written to your instructions
Send the scenario your section supplied and the staging reference it marks against, and a custom example is built on that reference and returned inside 24 to 48 hours, the first one free. If your classroom posted a worksheet file, attach it, and the example arrives inside the file rather than as a document you have to copy across.
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PA 512 Week 6 questions, answered
Our scenario never mentions one of the components. Can the worksheet be finished?
Yes, and finishing it correctly is part of the exercise. The component takes the unassessed marker, the source column says the scenario is silent on it, and the group is read as far as the reference allows with that entry in place. Send the scenario and the reference, and the example handles the gap rather than filling it.
Does each row need a reason as well as a source?
Sections differ. Many want the source only, since the reference already supplies the rule, and a few ask for a clause saying why the finding meets that rule. The second is quick to add and never costs marks where it was not required. Send the rubric row itself, and the example is written at the level of explanation named there.
Is a restaging worksheet built the same way?
The rows and the sourcing work the same and the prefix changes, which is the whole point of the exercise where a section sets one. Restaging after treatment is recorded as its own assessment rather than as an edit to the first, so both sets stay on the page. Send the assignment and the example keeps them separate.
Where can I find a free PA 512 Week 6 sample paper?
You can read a complete PA 512 Week 6 TNM staging worksheet for a testicular germ cell tumor, with a source for every component, on this page.
Why is the S category S1 rather than S2 in the PA 512 Week 6 sample?
Because staging uses marker values after orchiectomy; the earlier AFP of 1,480 would have been S2, but the post-surgery value of 690 places it in S1.