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Staging System and Excision Types
Tae Won Kim, MD
PCOM Tumor Review
4.23.16
Cancer Staging
1. What is cancer staging?
2. Why do we do it?
3. What is the most commonly utilized staging
system?
4. What factors are taken into account?
5. What are the staging system used in bone
and soft tissue sarcomas?
What is cancer staging?
“Cancer staging is the process of determining
how much cancer is in the body and where it is
located. Staging describes the severity of an
individual's cancer based on the magnitude of
the original (primary) tumor as well as on the
extent cancer has spread in the body”
-American Joint Committee on Cancer
Why do we do it?
1. Helps develop prognosis for patients
2. Creates a standard communication tool for
doctors
What is the most commonly used
staging system?
AJCC
(American Joint Committee on
Cancer)
What factors are taken into
account?
• T – Primary tumor size/extent
• N – Nodal involvement
• M – Metastatic lesions
• Example: Breast
• Individualized
AJCC for each type
of cancer
• T, N, M defined
differently for
each cancer type
What are the staging system used
in bone and soft tissue sarcomas?
Bone Sarcomas
Soft Tissue Sarcoma
Types of Margins
A 13-year-old girl presents with an isolated distal femur osteosarcoma that
extends into the soft tissue. Work-up is negative for metastasis, but biopsy
reveals a high grade lesion. What is the stage of this tumor by the
Musculoskeletal Tumor Society system?
1. I A
2. II A
3. I B
4. II B
5. III
This patient has a osteosarcoma that is high grade, extracompartment, and without
metastases, so it is a IIB by the MSTS Staging System. This is the most common MSTS
stage for an osteosarcoma to present. Here is a review of the stages in the MSTS
(Enneking) Staging System:
(I-A = Low Grade, intracompartmental, No Metastases);
(I-B = Low Grade, extracompartment, No Metastases);
(II-A = High Grade, intracompartmental, No Metastases);
(II-B = High Grade, extracompartment, No Metastases);
(III = Any Grade, Distant Metastases).