Cancer staging systems
Cancer staging systems are something pathologists ought to be familiar with.
Overview
Systems
- TNM staging system - most common, and used for the most common (adult) cancers.
- World Health Organization (WHO) grading system - for CNS tumours.
- Durie-Salmon system - multiple myeloma.
- Ann Arbour system - for Hodgkin lymphoma and non-Hodgkin lymphoma (excluding mycosis fungoides and Sezary syndrome).
- St. Jude system - pediatric pathology.
Stage
Most system are four tiered and use Roman numerals to denote the stage:
- Stage I: early cancer.
- Stage II: late early cancer (cancer between early and advanced stage).
- Stage III: advanced cancer - often defined by lymph node metastasis.
- Stage IV: late advanced cancer - often defined by metastasis.
TNM staging system
- Name of the system comes from the elements: Tumour, Nodes (lymph nodes), Metastasis (distant).
- Most common staging system.
- Staging parameters dependent on the specific site.
Modifiers
Table of modifiers:[1]
| Modifier | Meaning | Example | Notes |
|---|---|---|---|
| m | multiple tumours | pT(m)NM or pT2(2)N0Mx | tumour stage = highest stage of all the individual tumours |
| c | clinical stage | cTNM | if it is not specified clinical is assumed |
| p | pathologic stage | pTNM | derived from a surgical specimen or biopsy |
| a | stage at autopsy | aTNM | malignancy was not staged previously or treated - unless otherwise specified |
| y | staging after therapy | ypTNM | do not try to estimate pretreatment stage |
| r | recurrent tumour stage | rTNM | must have a clinically documented disease freedom |
Tumour stage
Usually determined by one of the following:
- Size of the tumour (maximal dimension).
- Depth of invasion.
Other factors:
- Lymphovascular invasion usually does not affect the tumour stage.
- Exceptions:
- Seminoma.
- Intrahepatic bile duct carcinoma.
- Hepatocellular carcinoma.[2]
- Exceptions:
- Margin status usually does not affect the tumour stage.
- Exception:
- Prostate adenocarcinoma - bladder neck margin positivity.
- Exception:
Nodal stage
- Lymph node involvement.
- Positive lymph nodes (without mets) often upstage to stage III.
- May upstage to stage II in some tumours.
- Sampling may be selective (sentinel lymph nodes).
Metastasis stage
See also
References
- ↑ URL: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page3. Accessed on: 28 March 2012.
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf. Accessed on: 6 April 2012.