Transcript Staging
STAGING
MCR Staff
Show Me Healthy Women
March 27, 2008
Supported by a Cooperative Agreement between DHSS and the
Centers for Disease Control and Prevention (CDC) and a
Surveillance Contract between DHSS and MU
Staging
Grouping of cancer cases
according to similar degrees of
spread or extent of disease.
Extent of disease is a detailed
description of how far the tumor
has spread from organ or site of
origin (the primary site).
Staging
PURPOSES
Determine
appropriate treatment
Predict prognosis
Evaluate results of treatment
Facilitate exchange of information
Contribute to research of human
cancer
Staging Elements
Elements to be considered in any
staging system are the
primary
tumor site,
tumor size,
multiplicity (number of tumors),
depth of invasion and extension to regional
or distant tissues,
involvement of regional lymph nodes, and
distant metastases.
Types of Staging Systems
Summary Staging
American Joint Committee on Cancer
(AJCC) Staging System
Collaborative Staging
Others
FIGO
(GYN)
Dukes (colorectal)
Ann Arbor ( Lymphoma)
FIGO
Acronym for the French term that
means International Federation for
Gynecology and Obstetrics. The
American Joint Committee on Cancer
has developed the tumor (T) component
of the TNM staging system to
correspond to FIGO staging.
How to?
Where did the cancer start?
Where did the cancer go?
How did the cancer get there?
What is the stage?
Staging Sources
Physical Exam
Radiologic Procedures
X-rays
Scans
Endoscopies
Tumor markers
Pathologic exams
Surgical reports
Progress Notes and Discharge Summaries
How Cancer Spreads
Local invasion
Direct extension
Lymphatic metastases
Blood-borne metastases
Intra-cavitary
Summary Staging
0 – in situ
1 – localized
2 – regional by direct extension only
3 – regional lymph nodes involved only
4 – regional by both direct extension and
lymph node involvement
5 – regional, NOS (not otherwise specified)
7 - distant site(s)/node(s) involved
9 – unknown (unstaged, unknown or
unspecified)
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In Situ Terms
CIN III
Confined to epithelium
Intracystic, non-infiltrating
Intraductal
Intraepidermal
Intra-epithelial
Intrasquamous
Stage 0
In Situ Terms
Involvement up to but not including
the basement membrane
Lobular neoplasia
Non-infiltrating
Non-invasive
No stromal invasion
Preinvasive
CIN III
CIN III (cervical intraepithelial neoplasia
grade iii) must be carefully reviewed,
because this diagnosis includes both
carcinoma in situ and severe dysplasia.
Microinvasion
Microinvasion implies invasion through
the basement membrane. The stage
would be INVASIVE not insitu.
Any foci of invasion makes the stage
invasive rather than insitu.
training.seer.cancer.gov
training.seer.cancer.gov
Distant
Distant mets can be by:
direct
contiguous extension
implantation (discontinuous) mets
lymph node involvement
Unstageable
Unknown primaries
Not enough information to stage
Death certificate only
AJCC (TNM) Staging
Louanne Currence, RHIT, CTR
What is TNM Staging?
Developed by physicians (AJCC)
Uniform staging system to determine
treatment, prognosis & end results
T = Tumor
N = Nodes
M = Metastasis
Group Stage = summary of TNM
Clinical Staging
Used to select primary treatment
Each site has specific guidelines of
what is acceptable under cTNM
Physical exam
Radiology
Endoscopy
Biopsy
Pathologic Staging
Based on pre-treatment evidence
and/or subsequent surgery/path
Used to
Determine
adjuvant therapy
Estimate prognosis
Report end results
T
Primary "Tumor" and its contiguous
extension
Based on size (invasive only)
Based on penetration
Extension of primary
T
T-value increases with worsening
scenario
Tx - cannot assess
T0 - no evidence of primary
Tis - In situ (never sarcomas)
T1-4
Sample "T"s
< 1.0 cm breast lesion = T1
3.0 cm LOQ breast lesion = T2
Carcinoma confined to uterus = T1
Cervical carcinoma extends to
pelvic wall = T3
N
Regional lymph nodes
Absence
or presence of + LN
# of + LNs/size of metastasis
Laterality of + LNs/size of mets
Named LN chains
N
Increases in severity
Nx
- cannot assess
N0 - no regional LN mets
N1-3
Sample "N"s
Breast
Metastasis
in axillary LNs fixed or
matted = N2
1 of 15 axillary LNs + (breast) = N1
Cervix
1
+ pelvic node = N1
M
Some sites have listing
Mx - cannot assess
M0 - no distant mets
M1 - distant mets found
Group Stage
Is the general reference point of
comparison
Tis = Stage 0
Stage I, Stage II, Stage III, Stage IV
Group Stage Examples (Breast)
Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
Stage IIA
T0
N1
M0
~~~~~
~~~~~
~~~~
~~~
Stage IIIB
T4
N0
M0
Stage IIIC
Any T
N3
M0
Stage IV
Any T
Any N
M1
Group Stage Samples (Cervix)
Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
Stage IIA
T2a
N0
M0
~~~~~
~~~~~
~~~~
~~~
Stage IIIB
T1
N1
M0
T2
N1
M0
Any T
Any N
M1
Stage IV
Collaborative Stage
Collaborative Staging (CS) data items
CS
Extension
CS Lymph Nodes
CS Mets at Dx
Steps for Staging
1) Determine primary site & histology
3) Is histology included?
4) Review list of regional LNs
5) Review rules of classification
6) Find staging information in chart
7) Determine T, N, M and group stage
Exercises
Missouri Cancer Registry
Help Line: 800-392-2829
Help interpreting path report for staging
http://mcr.umh.edu
For further information, please contact:
Sue Vest, Project Manager,
[email protected]
Nancy Cole, Assistant Project Manager
[email protected]