Cancer staging Flashcards
Lung cancer T staging
T: primary tumour
Tx: primary tumour cannot be assessed or tumour proven by the presence of malignant cells in sputum or bronchial washings but not visualised by imaging or bronchoscopy
T0: no evidence of a primary tumour
Tis: carcinoma in situ - tumour measuring 3 cm or less and has no invasive component at histopathology
T1: tumour measuring 3 cm or less in greatest dimension surrounded by lung or visceral pleura without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e. not in the main bronchus)
T1a(mi): minimally invasive adenocarcinoma
tumour has an invasive component measuring 5 mm or less at histopathology
T1a ss: superficial spreading tumour in central airways (spreading tumour of any size but confined to the tracheal or bronchial wall)
T1a: tumour ≤1 cm in greatest dimension
T1b: tumour >1 cm but ≤2 cm in greatest dimension
T1c: tumour >2 cm but ≤3 cm in greatest dimension
T2: tumour >3 cm but ≤5 cm or tumour with any of the following features:
involves the main bronchus regardless of distance from the carina but without the involvement of the carina
invades visceral pleura
associated with atelectasis or obstructive pneumonitis that extends to the hilar region (involving part or all of the lung)
T2a: tumour >3 cm but ≤4 cm in greatest dimension
T2b: tumour >4 cm but ≤5 cm in greatest dimension
T3: tumour >5 cm but ≤7 cm in greatest dimension or associated with separate tumour nodule(s) in the same lobe as the primary tumour or directly invades any of the following structures:
chest wall (including the parietal pleura and superior sulcus)
phrenic nerve
parietal pericardium
T4:
tumour
> 7 cm in greatest dimension or
associated with separate tumour nodule(s) in a different ipsilateral lobe than that of the primary tumour
or
invades any of the following structures
diaphragm
mediastinum
heart
great vessels
trachea
recurrent laryngeal nerve
oesophagus
vertebral body
carina
It is recommended that solid and non-solid lesions should be measured on the image that shows the greatest tumour dimension (on axial, coronal, or sagittal planes). Although those lesions that are part solid should be measured on both their largest average diameter and the largest diameter of the solid component, only the solid component measurement is to be used for staging 3. The solid component of subsolid lesions should be measured on a lung or intermediate window rather than mediastinal window 3.
For those centrally located lung tumours associated with peripheral post-obstructive atelectasis, FDG-PET-CT is useful in further delineating the real tumour size and, leading to a more precise T staging and a smaller targeted volume in radiation treatment planning.
Lung cancer N staging
N: regional lymph node involvement
Nx: regional lymph nodes cannot be assessed
N0: no regional lymph node metastasis
N1: metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2: metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3: metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
Lung cancer M staging
M: distant metastasis
M0: no distant metastasis
M1: distant metastasis present
M1a: separate tumour nodule(s) in a contralateral lobe; tumour with pleural or pericardial nodule(s) or malignant pleural or pericardial effusions
M1b: single extrathoracic metastasis, involving a single organ or a single distant (nonregional) node
a single extrathoracic metastasis has a better survival and different treatment choices, which is why it has now been staged separately
M1c: multiple extrathoracic metastases in one or more organs
Thoracic lymph node stations
https://radiopaedia.org/cases/thoracic-lymph-node-stations-annotated-ct
Superior mediastinal: stations 1 (supraclac), 2, 3, 4
Inferior mediastinal: stations 7(subcarinal),8,9
Aortic: stations 5,6
N1 nodes
Stations 10 (hilar),11(interlobar), 12, 13, 14
Prostate cancer TNM
TNM staging
Clinical primary tumour staging (cT)
TX: primary tumour cannot be assessed
T0: no evidence of primary tumour
T1: a clinically inapparent tumour that is not palpable
T1a: tumour incidental histologic finding in 5% or less of tissue resected
T1b: tumour incidental histologic finding in more than 5% of tissue resected
T1c: tumour identified by needle biopsy found in one or both sides, but not palpable
T2: tumour is palpable and confined within the prostate
T2a: tumour involves one-half of one side or less
T2b: tumour involves more than one-half of one side but not both sides
T2c: tumour involves both sides
T3: an extraprostatic tumour that is not fixed or does not invade adjacent structures
T3a: extraprostatic extension (unilateral or bilateral)
T3b: tumour invades seminal vesicle(s)
T4: tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
Pathological primary tumour staging (pT)
T2: organ confined
T3: extraprostatic extension
T3a: extraprostatic extension (unilateral or bilateral) or microscopic invasion of the bladder neck
T3b: tumour invades seminal vesicle(s)
T4: tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
Regional nodal status (N)
Regional lymph nodes are defined as those of the true pelvis (i.e. pelvic nodes below the bifurcation of the common iliac arteries).
Nodal status is based on PSMA PET-CT, MRI or CT. On MRI/CT a 1 cm short-axis diameter cut-off is used if the size is the sole criterion for adenopathy 1.
NX: regional nodes were not assessed
N0: no positive regional nodes
N1: metastases in regional node(s)
Distant metastasis (M)
M0: no distant metastasis
M1: distant metastasis
M1a: non-regional lymph node(s)
note that a node along the common iliac arteries would be considered M1a, not N1
M1b: bone(s)
M1c: other site(s) with or without bone disease
e.g. lungs, liver, brain
Gleason score
The Gleason grade, originally described in 1974, describes the histologic pattern of gland arrangement 2. Gleason grade patterns are assigned from 1 to 5:
1: well formed glands (least aggressive)
5: lacking gland formation (most aggressive)
Grade Group 1: <= 6
Grade Group 2: 7 (3+4)
Grade Group 3: 7 (4+3)
Grade Group 4: 8
Grade Group 5: 9 or 10
5-year biochemical risk-free survival after radical prostatectomy:
Grade Group 1: 96%
Grade Group 2: 88%
Grade Group 3: 63%
Grade Group 4: 48%
Grade Group 5: 26%
RCC staging
Primary tumour staging (T)
Tx: tumour cannot be assessed
T0: tumour not seen
T1
T1a: tumour confined to kidney, <4 cm
T1b: tumour confined to kidney, >4 cm but <7 cm
T2: limited to kidney >7 cm
T2a: tumour confined to kidney, >7 cm but not >10 cm
T2b: tumour confined to kidney, >10 cm
T3: tumour extension into major veins or perinephric tissues, but not into ipsilateral adrenal gland or beyond Gerota’s fascia
T3a: tumour grossly extends into the renal vein or its segmental (muscle-containing) branches, invades the pelvicalyceal system, or invades perirenal and/or renal sinus fat but not beyond the Gerota fascia
T3b: spread to infra diaphragmatic IVC
T3c: spread to supra diaphragmatic IVC or invades the wall of the IVC
T4: involves ipsilateral adrenal gland or invades beyond Gerota’s fascia
Regional lymph nodes (N)
N0: no nodal involvement
N1: metastatic involvement of regional lymph node(s)
Metastases (M)
M0: no distant metastases
M1: distant metastases
