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.

STAGING

MCR StaffShow Me Healthy Women

March 27, 2008Supported 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

PURPOSESDetermine appropriate treatmentPredict prognosisEvaluate results of treatmentFacilitate exchange of informationContribute 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 invasionDirect extensionLymphatic metastasesBlood-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)

training.seer.cancer.gov

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 extensionimplantation (discontinuous) metslymph 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 treatmentEach 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 therapyEstimate prognosisReport end results

TPrimary "Tumor" and its contiguous

extensionBased on size (invasive only)Based on penetrationExtension of primary

TT-value increases with worsening

scenarioTx - cannot assessT0 - no evidence of primaryTis - In situ (never sarcomas)T1-4

Sample "T"s

< 1.0 cm breast lesion = T13.0 cm LOQ breast lesion = T2Carcinoma confined to uterus = T1Cervical carcinoma extends to

pelvic wall = T3

NRegional lymph nodes

Absence or presence of + LN# of + LNs/size of metastasis Laterality of + LNs/size of mets Named LN chains

N

Increases in severityNx - cannot assessN0 - no regional LN metsN1-3

Sample "N"s

BreastMetastasis in axillary LNs fixed or

matted = N21 of 15 axillary LNs + (breast) = N1

Cervix1 + pelvic node = N1

MSome sites have listingMx - cannot assessM0 - no distant metsM1 - distant mets found

Group Stage

Is the general reference point of comparison

Tis = Stage 0Stage 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

Stage IV Any T Any N M1

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 RegistryHelp Line: 800-392-2829

Help interpreting path report for staginghttp://mcr.umh.edu

For further information, please contact:Sue Vest, Project Manager,

[email protected] Cole, Assistant Project Manager

[email protected]