Cancer staging systems

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Cancer staging systems are something pathologists ought to be familiar with.

Overview

Systems

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:

  1. Size of the tumour (maximal dimension).
  2. Depth of invasion.

Other factors:

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