staging l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
STAGING PowerPoint Presentation
Download Presentation
STAGING

Loading in 2 Seconds...

play fullscreen
1 / 39

STAGING - PowerPoint PPT Presentation


  • 419 Views
  • Uploaded on

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 (CDC) and a Surveillance Contract between DHSS and MU. Staging.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'STAGING' - oshin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
staging

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 (CDC) and a Surveillance Contract between DHSS and MU

staging2
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).

staging3
Staging
  • PURPOSES
    • Determine appropriate treatment
    • Predict prognosis
    • Evaluate results of treatment
    • Facilitate exchange of information
    • Contribute to research of human cancer
staging elements
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
Types of Staging Systems
  • Summary Staging
  • American Joint Committee on Cancer (AJCC) Staging System
  • Collaborative Staging
  • Others
    • FIGO (GYN)
    • Dukes (colorectal)
    • Ann Arbor ( Lymphoma)
slide6
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
How to?
  • Where did the cancer start?
  • Where did the cancer go?
  • How did the cancer get there?
  • What is the stage?
staging sources
Staging Sources
  • Physical Exam
  • Radiologic Procedures
    • X-rays
    • Scans
    • Endoscopies
  • Tumor markers
  • Pathologic exams
  • Surgical reports
  • Progress Notes and Discharge Summaries
how cancer spreads
How Cancer Spreads
  • Local invasion
  • Direct extension
  • Lymphatic metastases
  • Blood-borne metastases
  • Intra-cavitary
summary staging
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)
in situ terms
In Situ Terms
  • CIN III
  • Confined to epithelium
  • Intracystic, non-infiltrating
  • Intraductal
  • Intraepidermal
  • Intra-epithelial
  • Intrasquamous
  • Stage 0
in situ terms14
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
  • CIN III (cervical intraepithelial neoplasia grade iii) must be carefully reviewed, because this diagnosis includes both carcinoma in situ and severe dysplasia.
microinvasion
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.
distant
Distant
  • Distant mets can be by:
    • direct contiguous extension
    • implantation (discontinuous) mets
    • lymph node involvement
unstageable
Unstageable
  • Unknown primaries
  • Not enough information to stage
  • Death certificate only
ajcc tnm staging louanne currence rhit ctr
AJCC (TNM) Staging

Louanne Currence, RHIT, CTR

what is tnm staging
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
Clinical Staging
  • Used to select primary treatment
  • Each site has specific guidelines of what is acceptable under cTNM

Physical exam Radiology

Endoscopy Biopsy

pathologic staging
Pathologic Staging
  • Based on pre-treatment evidence and/or subsequent surgery/path
  • Used to
    • Determine adjuvant therapy
    • Estimate prognosis
    • Report end results
slide26
T
  • Primary "Tumor" and its contiguous extension
    • Based on size (invasive only)
    • Based on penetration
    • Extension of primary
slide27
T
  • T-value increases with worsening scenario
    • Tx - cannot assess
    • T0 - no evidence of primary
    • Tis - In situ (never sarcomas)
    • T1-4
sample t s
Sample "T"s
  • < 1.0 cm breast lesion = T1
  • 3.0 cm LOQ breast lesion = T2
  • Carcinoma confined to uterus = T1
  • Cervical carcinoma extends to pelvic wall = T3
slide29
N
  • Regional lymph nodes
    • Absence or presence of + LN
    • # of + LNs/size of metastasis
    • Laterality of + LNs/size of mets
    • Named LN chains
slide30
N
  • Increases in severity
    • Nx - cannot assess
    • N0 - no regional LN mets
    • N1-3
sample n s
Sample "N"s
  • Breast
    • Metastasis in axillary LNs fixed or matted = N2
    • 1 of 15 axillary LNs + (breast) = N1
  • Cervix
    • 1 + pelvic node = N1
slide32
M
  • Some sites have listing
  • Mx - cannot assess
  • M0 - no distant mets
  • M1 - distant mets found
group stage
Group Stage
  • Is the general reference point of comparison
  • Tis = Stage 0
  • Stage I, Stage II, Stage III, Stage IV
collaborative stage
Collaborative Stage
  • Collaborative Staging (CS) data items
    • CS Extension
    • CS Lymph Nodes
    • CS Mets at Dx
steps for staging
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

slide39
Missouri Cancer Registry

Help Line: 800-392-2829

Help interpreting path report for staging

http://mcr.umh.edu

For further information, please contact:

Sue Vest, Project Manager, vests@health.missouri.edu

Nancy Cole, Assistant Project Manager

colen@health.missouri.edu