Cancer staging systems

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

Overview

  • 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.

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

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