Cancer staging systems
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Cancer staging systems are something pathologists ought to be familiar with. They classify cancers based on the extent of tumour or the location of the tumour in relation to where it arose.
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.