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CancerstagingWikipedia,thefreeencyclopedia

Cancerstaging
FromWikipedia,thefreeencyclopedia

Cancerstagingistheprocessofdeterminingtheextenttowhichacancerhasdevelopedbyspreading.
ContemporarypracticeistoassignanumberfromItoIVtoacancer,withIbeinganisolatedcancerand
IVbeingacancerwhichhasspreadtothelimitofwhattheassessmentmeasures.Thestagegenerally
takesintoaccountthesizeofatumor,whetherithasinvadedadjacentorgans,howmanyregional
(nearby)lymphnodesithasspreadto(ifany),andwhetherithasappearedinmoredistantlocations
(metastasized).

Contents
1 TNMstagingsystem
2 Considerations
2.1 Pathologic
2.2 Currentresearch
3 Systems
3.1 Blood
3.2 Solid
4 Overallstagegrouping
5 Stagemigration
6 References
7 Externallinks

TNMstagingsystem
Cancerstagingcanbedividedintoaclinicalstageandapathologicstage.IntheTNM(Tumor,Node,
Metastasis)system,clinicalstageandpathologicstagearedenotedbyasmall"c"or"p"beforethestage
(e.g.,cT3N1M0orpT2N0).Thisstagingsystemisusedformostformsofcancer,exceptbraintumors
andhematologicalmalignancies.
Clinicalstageisbasedonalloftheavailableinformationobtainedbeforeasurgerytoremovethe
tumor.Thus,itmayincludeinformationaboutthetumorobtainedbyphysicalexamination,blood
tests,radiologicexamination,biopsy,andendoscopy.
Pathologicstageaddsadditionalinformationgainedbyexaminationofthetumormicroscopically
byapathologistafterithasbeensurgicallyremoved.

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Becausetheyusedifferentcriteria,clinicalstageandpathologicstageoftendiffer.Pathologicstagingis
usuallyconsideredtobemoreaccuratebecauseitallowsdirectexaminationofthetumorinitsentirety,
contrastedwithclinicalstagingwhichislimitedbythefactthattheinformationisobtainedbymaking
indirectobservationsofatumorwhichisstillinthebody.However,clinicalstagingandpathologic
stagingoftencomplementeachother.Noteverytumoristreatedsurgically,thereforepathologicstaging
isnotalwaysavailable.Also,sometimessurgeryisprecededbyothertreatmentssuchaschemotherapy
andradiationtherapywhichshrinkthetumor,sothepathologicstagemayunderestimatethetruestage.

Considerations
Correctstagingiscriticalbecausetreatment(particularlytheneedforpreoperativetherapyand/orfor
adjuvanttreatment,theextentofsurgery)isgenerallybasedonthisparameter.Thus,incorrectstaging
wouldleadtoimpropertreatment.
Forsomecommoncancersthestagingprocessiswelldefined.Forexample,inthecasesofbreastcancer
andprostatecancer,doctorsroutinelycanidentifythatthecancerisearlyandthatithaslowriskof
metastasis.[1]Insuchcases,medicalspecialtyprofessionalorganizationsrecommendagainsttheuseof
PETscans,CTscans,orbonescansbecauseresearchshowsthattheriskofgettingsuchprocedures
outweighsthepossiblebenefits.[1]Someoftheproblemsassociatedwithovertestingincludepatients
receivinginvasiveprocedures,overutilizingmedicalservices,gettingunnecessaryradiationexposure,
andexperiencingmisdiagnosis.[1]

Pathologic
Pathologicstaging,whereapathologistexaminessectionsoftissue,canbeparticularlyproblematicfor
twospecificreasons:visualdiscretionandrandomsamplingoftissue."Visualdiscretion"meansbeing
abletoidentifysinglecancerouscellsintermixedwithhealthycellsonaslide.Oversightofonecellcan
meanmistagingandleadtoserious,unexpectedspreadofcancer."Randomsampling"referstothefact
thatlymphnodesarecherrypickedfrompatientsandrandomsamplesareexamined.Ifcancerouscells
presentinthelymphnodehappennottobepresentintheslicesoftissueviewed,incorrectstagingand
impropertreatmentcanresult.

Currentresearch
New,highlysensitivemethodsofstagingareindevelopment.Forexample,themRNAforGCC
(guanylylcyclasec),presentonlyintheluminalaspectofintestinalepithelium,canbeidentifiedusing
molecularscreening(RTPCR)withahighdegreeofsensitivityandexactitude.PresenceofGCCinany
othertissueofthebodyrepresentscolorectalmetaplasia.Becauseofitshighsensitivity,RTPCR
screeningforGCCgreatlyreducesunderestimationofdiseasestage.Researchershopethatstagingwith
thislevelofprecisionwillleadtomoreappropriatetreatmentandbetterprognosis.Furthermore,
researchershopethatthissametechniquecanbeappliedtoothertissuespecificproteins.

Systems
Stagingsystemsarespecificforeachtypeofcancer(e.g.,breastcancerandlungcancer).Somecancers,
however,donothaveastagingsystem.Althoughcompetingstagingsystemsstillexistforsometypesof
cancer,theuniversallyacceptedstagingsystemisthatoftheUICC,whichhasthesamedefinitionsof
individualcategoriesastheAJCC.

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Systemsofstagingmaydifferbetweendiseasesorspecificmanifestationsofadisease.

Blood
Lymphoma:usesAnnArborstaging
Hodgkin'sDisease:followsascalefromItoIVandcanbeindicatedfurtherbyanAorB,
dependingonwhetherapatientisnonsymptomaticorhassymptomssuchasfevers.Itisknown
asthe"CotswoldSystem"or"ModifiedAnnArborStagingSystem".[2]

Solid
Forsolidtumors,TNMisbyfarthemostcommonlyusedsystem,butithasbeenadaptedforsome
conditions.
Breastcancer:Inbreastcancerclassification,stagingisusuallybasedonTNM,[3]butstaginginI
IVmaybeusedaswell.
Cervicalandovariancancers:the"FIGO"systemhasbeenadoptedintotheTNMsystem.For
premalignantdysplasticchanges,theCIN(cervicalintraepithelialneoplasia)gradingsystemis
used.[4]
Coloncancer:originallyconsistedoffourstages:A,B,C,andD(theDukesstagingsystem).
Morerecently,coloncancerstagingisindicatedeitherbytheoriginalADstagesorbyTNM.[5]
Kidneycancer:usesTNM.[6]
Cancerofthelarynx:UsesTNM.[7]
Livercancer:UsesTNM.[8]
Lungcancer:usesTNM.[9]
Melanoma:TNMused.Alsoofimportancearethe"Clarklevel"and"Breslowdepth"whichrefer
tothemicroscopicdepthoftumorinvasion("Microstaging").[10]
Prostatecancer:TNMalmostuniversallyused.[11]
Testicularcancer:usesTNMalongwithameasureofbloodserummarkers(TNMS).[12]
Nonmelanomaskincancer:usesTNM.[13]
Bladdercancer:usesTNM.[14]

Overallstagegrouping
OverallStage
Groupingisalso
referredtoasRoman
NumeralStaging.This
systemusesnumerals
I,II,III,andIV(plus
the0)todescribethe
progressionofcancer.
Stage0:
carcinomain
situ.
StageI:cancers
arelocalizedto
onepartofthe
body.StageIcancercanbesurgicallyremovedifsmallenough.
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StageII:cancersarelocallyadvanced.StageIIcancercanbetreatedbychemo,radiation,or
surgery.
StageIII:cancersarealsolocallyadvanced.WhetheracancerisdesignatedasStageIIorStage
IIIcandependonthespecifictypeofcancerforexample,inHodgkin'sDisease,StageIIindicates
affectedlymphnodesononlyonesideofthediaphragm,whereasStageIIIindicatesaffected
lymphnodesaboveandbelowthediaphragm.ThespecificcriteriaforStagesIIandIIItherefore
differaccordingtodiagnosis.StageIIIcanbetreatedbychemo,radiation,orsurgery.
StageIV:cancershaveoftenmetastasized,orspreadtootherorgansorthroughoutthebody.
StageIVcancercanbetreatedbychemo,radiation,orsurgery.
WithintheTNMsystem,acancermayalsobedesignatedasrecurrent,meaningthatithasappeared
againafterbeinginremissionorafterallvisibletumorhasbeeneliminated.Recurrencecaneitherbe
local,meaningthatitappearsinthesamelocationastheoriginal,ordistant,meaningthatitappearsina
differentpartofthebody.

Stagemigration
Stagemigrationdescribeschangeinthedistributionofstageinaparticularcancerpopulationinducedby
eitherachangeinthestagingsystemitselforelseachangeintechnologywhichallowsmoresensitive
detectionoftumorspreadandthereforemoresensitivityindetectingspreadofdisease(e.g.,theuseof
MRIscan).Stagemigrationcanleadtocuriousstatisticalphenomena(forexample,theWillRogers
phenomenon).

References
1.AmericanSocietyofClinicalOncology,"FiveThingsPhysiciansandPatientsShouldQuestion"(PDF),
ChoosingWisely:aninitiativeoftheABIMFoundation(AmericanSocietyofClinicalOncology),retrieved
August14,2012,citing
Carlson,R.W.Allred,D.C.Anderson,B.O.Burstein,H.J.Carter,W.B.Edge,S.B.Erban,J.
K.Farrar,W.B.Goldstein,L.J.Gradishar,W.J.Hayes,D.F.Hudis,C.A.Jahanzeb,M.Kiel,
K.Ljung,B.M.Marcom,P.K.Mayer,I.A.McCormick,B.Nabell,L.M.Pierce,L.J.Reed,
E.C.Smith,M.L.Somlo,G.Theriault,R.L.Topham,N.S.Ward,J.H.Winer,E.P.Wolff,
A.C.NCCNBreastCancerClinicalPracticeGuidelinesPanel(2009)."Breastcancer.Clinical
practiceguidelinesinoncology".JournaloftheNationalComprehensiveCancerNetwork:JNCCN7
(2):122192.PMID19200416.
Thompson,I.Thrasher,J.B.Aus,G.Burnett,A.L.CanbyHagino,E.D.Cookson,M.S.
d'Amico,A.V.Dmochowski,R.R.Eton,D.T.Forman,J.D.Goldenberg,S.L.Hernandez,J.
Higano,C.S.Kraus,S.R.Moul,J.W.Tangen,C.M.AUAProstateCancerClinicalGuideline
UpdatePanel(2007)."GuidelinefortheManagementofClinicallyLocalizedProstateCancer:2007
Update".TheJournalofUrology177(6):21062131.doi:10.1016/j.juro.2007.03.003.
PMID17509297.
2."Hodgkin'sDiseaseStaging".oncologychannel.Retrieved20101014.
3."BreastCancerTreatmentNationalCancerInstitute".Cancer.gov.20100813.Retrieved20101014.
4.EricLucas(20060131)."FIGOstagingofcervicalcarcinomas".Screening.iarc.fr.Retrieved20101014.
5."ColonCancerStaging".oncologychannel.Retrieved20101014.
6."Stagesofkidneycancer".Cancerhelp.org.uk.20100630.Retrieved20101014.
7."Thestagesofcancerofthelarynx".Cancerhelp.org.uk.20100728.Retrieved20101014.
8."Howislivercancerstaged?".Retrieved20130602.
9.ImaginginLungCancerStaging(http://emedicine.medscape.com/article/362919overview)ateMedicine
10."malignantmelanoma:staging".Chorus.rad.mcw.edu.Retrieved20101014.
11."NCCNGuidelinesforPatients".NationalComprehensiveCancerNetwork.Retrieved20151101.
12.oncologist(http://www.credihealth.com/doctors/mumbairegion/oncologist)
13.CancerDoctors(http://www.credihealth.com/doctors/mumbairegion/cancer)
14."ACS:HowIsBladderCancerStaged?".Cancer.org.20100420.Retrieved20101014.
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Externallinks
"Staging:QuestionsandAnswers"attheNationalCancerInstitute
(http://www.cancer.gov/cancertopics/factsheet/Detection/staging)
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Cancer_staging&oldid=708753804"
Categories: Anatomicalpathology Cancerstaging
Thispagewaslastmodifiedon7March2016,at11:42.
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mayapply.Byusingthissite,youagreetotheTermsofUseandPrivacyPolicy.Wikipediaisa
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