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![Page 1: 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.](https://reader030.fdocuments.net/reader030/viewer/2022033106/56649c795503460f9492e382/html5/thumbnails/1.jpg)
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
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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).
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Staging
PURPOSESDetermine appropriate treatmentPredict prognosisEvaluate results of treatmentFacilitate exchange of informationContribute to research of human
cancer
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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.
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Types of Staging Systems
Summary Staging American Joint Committee on Cancer
(AJCC) Staging System Collaborative Staging Others
FIGO (GYN) Dukes (colorectal) Ann Arbor ( Lymphoma)
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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.
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How to?
Where did the cancer start? Where did the cancer go? How did the cancer get there? What is the stage?
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Staging Sources
Physical Exam Radiologic Procedures
X-rays Scans Endoscopies
Tumor markers Pathologic exams Surgical reports Progress Notes and Discharge Summaries
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How Cancer Spreads
Local invasionDirect extensionLymphatic metastasesBlood-borne metastases Intra-cavitary
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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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training.seer.cancer.gov
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In Situ Terms
CIN III Confined to epithelium Intracystic, non-infiltrating Intraductal Intraepidermal Intra-epithelial Intrasquamous Stage 0
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In Situ Terms Involvement up to but not including
the basement membrane Lobular neoplasia Non-infiltrating Non-invasive No stromal invasion Preinvasive
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CIN III
CIN III (cervical intraepithelial neoplasia grade iii) must be carefully reviewed, because this diagnosis includes both carcinoma in situ and severe dysplasia.
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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.
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training.seer.cancer.gov
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training.seer.cancer.gov
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Distant
Distant mets can be by:direct contiguous extensionimplantation (discontinuous) metslymph node involvement
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Unstageable
Unknown primaries
Not enough information to stage
Death certificate only
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AJCC (TNM) Staging
Louanne Currence, RHIT, CTR
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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
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Clinical Staging
Used to select primary treatmentEach site has specific guidelines of
what is acceptable under cTNM
Physical exam Radiology
Endoscopy Biopsy
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Pathologic Staging
Based on pre-treatment evidence and/or subsequent surgery/path
Used to Determine adjuvant therapyEstimate prognosisReport end results
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TPrimary "Tumor" and its contiguous
extensionBased on size (invasive only)Based on penetrationExtension of primary
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TT-value increases with worsening
scenarioTx - cannot assessT0 - no evidence of primaryTis - In situ (never sarcomas)T1-4
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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
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NRegional lymph nodes
Absence or presence of + LN# of + LNs/size of metastasis Laterality of + LNs/size of mets Named LN chains
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N
Increases in severityNx - cannot assessN0 - no regional LN metsN1-3
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Sample "N"s
BreastMetastasis in axillary LNs fixed or
matted = N21 of 15 axillary LNs + (breast) = N1
Cervix1 + pelvic node = N1
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MSome sites have listingMx - cannot assessM0 - no distant metsM1 - distant mets found
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Group Stage
Is the general reference point of comparison
Tis = Stage 0Stage I, Stage II, Stage III, Stage IV
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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
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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
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Collaborative Stage
Collaborative Staging (CS) data items CS Extension CS Lymph Nodes CS Mets at Dx
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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
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Exercises
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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