Difference between revisions of "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.
[[Image:Diagram showing the T stages of bladder cancer CRUK 372.svg|thumb|right|180px|Schematic showing the T stages in bladder cancer. (WC/CRUK)]]
'''Cancer staging systems''' are used to prognosticate cancer and determine treatment. They classify cancers based on the extent of tumour or the location of the tumour in relation to where it arose.


=Overview=
=Overview=
===Systems===
===Systems===
*[[TNM staging system]] - most common, and used for the most common (adult) cancers.
*[[TNM staging system]] - most common, and used for the most common (adult) cancers.
*World Health Organization (WHO) grading system - for [[CNS tumours]].
*[[World Health Organization]] (WHO) grading system - for [[CNS tumours]].
*Durie-Salmon system - [[multiple myeloma]].
*St. Jude system - pediatric pathology.
*Durie-Salmon system - for [[multiple myeloma]].
*Ann Arbour system - for [[Hodgkin lymphoma]] and non-Hodgkin lymphoma (excluding [[mycosis fungoides]] and Sezary syndrome).
*Ann Arbour system - for [[Hodgkin lymphoma]] and non-Hodgkin lymphoma (excluding [[mycosis fungoides]] and Sezary syndrome).
*St. Jude system - pediatric pathology.
*[[Sheldon system]] - for [[urachal carcinoma]].<ref name=pmid22901574>{{Cite journal  | last1 = Bruins | first1 = HM. | last2 = Visser | first2 = O. | last3 = Ploeg | first3 = M. | last4 = Hulsbergen-van de Kaa | first4 = CA. | last5 = Kiemeney | first5 = LA. | last6 = Witjes | first6 = JA. | title = The clinical epidemiology of urachal carcinoma: results of a large, population based study. | journal = J Urol | volume = 188 | issue = 4 | pages = 1102-7 | month = Oct | year = 2012 | doi = 10.1016/j.juro.2012.06.020 | PMID = 22901574 }}</ref>
*[[Masaoka|Modified Masaoka staging system]] - for [[thymoma]].<ref name=pmid17337514>{{Cite journal  | last1 = Mori | first1 = T. | last2 = Nomori | first2 = H. | last3 = Ikeda | first3 = K. | last4 = Yoshioka | first4 = M. | last5 = Kobayashi | first5 = H. | last6 = Iwatani | first6 = K. | last7 = Yoshimoto | first7 = K. | last8 = Iyama | first8 = K. | title = Three cases of multiple thymoma with a review of the literature. | journal = Jpn J Clin Oncol | volume = 37 | issue = 2 | pages = 146-9 | month = Feb | year = 2007 | doi = 10.1093/jjco/hyl147 | PMID = 17337514 }}</ref><ref name=pmid8044305>{{Cite journal  | last1 = Koga | first1 = K. | last2 = Matsuno | first2 = Y. | last3 = Noguchi | first3 = M. | last4 = Mukai | first4 = K. | last5 = Asamura | first5 = H. | last6 = Goya | first6 = T. | last7 = Shimosato | first7 = Y. | title = A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. | journal = Pathol Int | volume = 44 | issue = 5 | pages = 359-67 | month = May | year = 1994 | doi =  | PMID = 8044305 }}</ref>


===Stage===
===Stage===
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==TNM staging system==
==TNM staging system==
*Name of the system comes from the elements: '''T'''umour, '''N'''odes (lymph nodes), '''M'''etastasis (distant).
*Name of the system comes from the elements: '''T'''umour, '''N'''odes ([[lymph nodes]]), '''M'''etastasis (distant).
*Most common staging system.
*Most common staging system.
*Staging parameters dependent on the specific site.
*Staging parameters dependent on the specific site.
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***[[Hepatocellular carcinoma]].<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf]. Accessed on: 6 April 2012.</ref>
***[[Hepatocellular carcinoma]].<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf]. Accessed on: 6 April 2012.</ref>
*[[Margin status]] usually does not affect the tumour stage.
*[[Margin status]] usually does not affect the tumour stage.
**Exception:
**[[Prostate adenocarcinoma]] - on a practical level bladder neck margin positivity usually up stages, see ''[[bladder neck invasion]]''.
***[[Prostate adenocarcinoma]] - bladder neck margin positivity.


===Nodal stage===
===Nodal stage===
*[[Lymph node]] involvement.
{{Main|Lymph node metastasis}}
*[[lymph node metastasis|Lymph node involvement]].
*Positive lymph nodes (without mets) often upstage to ''stage III''.
*Positive lymph nodes (without mets) often upstage to ''stage III''.
**May upstage to ''stage II'' in some tumours.
**May upstage to ''stage II'' in some tumours.
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=See also=
=See also=
*[[Cancer]].
*[[Cancer]].
*[[Diagnostic size cutoffs]].


=References=
=References=
{{Reflist|1}}
{{Reflist|1}}
=External links=
*[http://www.cancer.gov/cancertopics/factsheet/detection/staging Cancer staging (cancer.gov)] - an overview directed at individuals with cancer.


[[Category:Basics]]
[[Category:Basics]]
[[Category:Cancer staging]]

Latest revision as of 14:16, 2 January 2017

Schematic showing the T stages in bladder cancer. (WC/CRUK)

Cancer staging systems are used to prognosticate cancer and determine treatment. They classify cancers based on the extent of tumour or the location of the tumour in relation to where it arose.

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:[4]

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

Main article: Lymph node metastasis

Metastasis stage

See also

References

  1. ↑ Bruins, HM.; Visser, O.; Ploeg, M.; Hulsbergen-van de Kaa, CA.; Kiemeney, LA.; Witjes, JA. (Oct 2012). "The clinical epidemiology of urachal carcinoma: results of a large, population based study.". J Urol 188 (4): 1102-7. doi:10.1016/j.juro.2012.06.020. PMID 22901574.
  2. ↑ Mori, T.; Nomori, H.; Ikeda, K.; Yoshioka, M.; Kobayashi, H.; Iwatani, K.; Yoshimoto, K.; Iyama, K. (Feb 2007). "Three cases of multiple thymoma with a review of the literature.". Jpn J Clin Oncol 37 (2): 146-9. doi:10.1093/jjco/hyl147. PMID 17337514.
  3. ↑ Koga, K.; Matsuno, Y.; Noguchi, M.; Mukai, K.; Asamura, H.; Goya, T.; Shimosato, Y. (May 1994). "A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma.". Pathol Int 44 (5): 359-67. PMID 8044305.
  4. ↑ URL: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page3. Accessed on: 28 March 2012.
  5. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf. Accessed on: 6 April 2012.

External links

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