Staging

Question 1

What is staging

Answer 1

The extent of the cancer

Question 2

What two groups are cancers split into

Answer 2

Survival rates higher → disease is localise

Survival lower → there is disease extension beyond the organ or site of origin

Question 3

What are the broad categories of cancer

Answer 3

Early and advanced

Question 4

What factors affect a patient’s outcome?

Answer 4

Anatomical site
•Reported duration of symptoms
•Sex, age and PS of patient
•Clinical extent of disease
•Pathological extent of the disease
•Clinical subtype

Question 5

Staging

Answer 5

A cancer is (nearly) always referred to by the stage it was given at diagnosis, even if it gets worse or spreads.
New information about how a cancer has changed over time is added on to the original stage.
So - stage doesn’t change, even though the cancer might

Question 6

What does in situ mean?

Answer 6

Abnormal cells are present but have not spread to nearby tissue.

Question 7

Localised

Answer 7

Cancer is limited to the place where it started, with no sign that it has spread.

Question 8

Regional

Answer 8

Cancer has spread to nearby lymph nodes, tissues, or organs.

Question 9

Distant

Answer 9

Cancer has spread to distant parts of the body.

Question 10

Unknown

Answer 10

There is not enough information to establish the stage.

Question 11

What is TNM

Answer 11

Cancer classification system

Question 12

What is the T in TNM

Answer 12

Size and extent of primary tumour

Question 13

What does the N in TNM mean?

Answer 13

Number of nearby lymph nodes that have cancer

Question 14

What does the M in TNM mean?

Answer 14

Has the cancer metastasised

Question 15

TNM benefits

Answer 15

Adapted to fit almost any tumour
Generally accepted globally
Expresses the anatomical extent of the disease
Shorthand to describe the clinical extent of a particular malignant tumour

Question 16

TNM

Answer 16

Indicates the extent of the spread

•This information is gained from:
●PHYSICAL
●RADIOLOGICAL
●ENDOSCOPIC
●SURGICAL procedures

Question 17

Clinical staging

Answer 17

based on information prior to surgery

Question 18

Pathological staging

Answer 18

based on surgical examination

Question 19

Tumour grading

Answer 19

TX: Main tumour cannot be measured.
•Tis : Tumour in situ (non-invasive)
•T0: Main tumour cannot be found.
•T1, T2, T3, T4: Refers to the size and/or extent of the main tumour.
•T’s may be further divided to provide more detail, such as T3a and T3b.
Clinical stag

Question 20

Distant metastasis

Answer 20

MX: Metastasis cannot be measured.
• M0: Cancer has not spread to other parts of the body.
• M1: Cancer has spread to other parts of the body.
• M1pul = pulmonary mets
• M1H = liver mets

Question 21

Systems that describe stage

Answer 21

Where the tumour is located in the body
• The cell type (such as, adenocarcinoma or squamous cell carcinoma)
• The size of the tumour
• Whether the cancer has spread to nearby lymph nodes

Question 22

Generic stage groupings

Answer 22

•Stage I – tumour confined to the organ of origin
•Stage II – local lymph nodes invaded
•Stage III – distant lymph nodes invaded, or local spread beyond origin.
•Stage IV – blood borne metastasis

Question 23

Cancer site specific staging systems

Answer 23

Lymphoma – Ann Arbor
•Cervical and Ovarian – FIGO
•Colon - Dukes
•Melanoma - Clarks level and Breslow depth in addition to TNM

Question 24

Bcc staging

Answer 24

BCCs are often not staged – Why might that be?

If a NMSC is potentially invasive it is staged using TNM, based on the maximum dimension of the skin tumour
T1 <2cm
T2 2cm≤5cm