Download importance of staging - American College of Surgeons

THE IMPORTANCE OF STAGING AND
PROGNOSTIC FACTORS IN CANCER CARE
AND USE OF NATIONAL GUIDELINES
THE IMPORTANCE OF STAGING AND
PROGNOSTIC FACTORS
IN CANCER CARE
•History of Staging
•Components of Staging(TNM)
•Clinical/Pathologic
•Prognostic Factors
•Future of Staging
HISTORY OF STAGING
•Staging begun over 100 years ago
•Various staging systems such as
Duke’s Staging of Colon Cancer
•Concept of TNM Started in 1940’s
HISTORY OF STAGING
(TNM)
•Concept of TNM Started in 1940’s
by French Surgeon Pierre Denoix
HISTORY OF STAGING
(TNM)
•1958 First International TNM
Recommendations for Breast
& Laryngeal Cancer by the
International Union Against Cancer
(IUCC)
•American Joint Commission on
Cancer (AJCC) Founded in 1959 and
works with IUCC so that the IUCC
and AJCC systems are identical
HISTORY OF STAGING
AJCC
AJCC has published 7 editions of their
Staging Manual
HISTORY OF STAGING
AJCC
•AJCC Eight Edition Will be available in 2016
•8th Edition to be used for patients
diagnosed after January 2017
•AJCC has several resources available including
staging forms and a staging atlas on their
website:
www.cancerstaging.org
COMPONENTS OF STAGING
TNM & Stage Group
•TNM system used to describe the anatomic
extent of the tumor
•T-Defines the extent of the tumor at the
primary site
•N-Describes presence or absence of
tumor in regional lymph nodes
•M-Designates the presence or absence in
sites beyond regional lymph nodes
COMPONENTS OF STAGING
TNM & Stage Group
•T-Usually 4 subgroups (T1 to T4)
•N-At least 2 subgroups (N0 & N1)
•M-At least 2 subgroups (M0 & M1)
•Other subcategories for N have been added for
various cancer types (e.g. breast has 6
subdivisions for N1 to better define the nodal
status
•Other subcategories for M (e.g. prostate cancer
has 3 subdivisions of M) to better define the
pattern of spread
COMPONENTS OF STAGING
TNM & Stage Group
•Comparison of each combination of TNM is too
complex.
•Stage groups are utilized to simplify comparison
•Each group should be comparable as far as
survival rates
•Stage I cancers are early and usually
survivable whereas Stage IV denotes
advanced disease
Clinical & Pathologic Stage
CLINCAL STAGE
The clinical stage is the stage determined by the clinician
based on physical examination, imaging tests, and
biopsy results. The clinical stage is used to guide
initial treatment decisions.
Clinical & PathologicStage
PATHOLOGIC STAGE
The pathologic stage is the stage determined after
surgery has been done to remove or determine the
extent of the tumor and or determine spread of
tumor to other structures such as lymph nodes. The
final pathologic stage may also utilize information
obtained clinically such as by imaging tests with the
results of surgery.
IMPORTANCE OF STAGING
•Used to stratify cancer patients into groups
•Determination of Prognosis
•Determine Best Therapy
•Allows for comparison among large populations
•Provides a framework for discussion”The language of cancer”
SITE SPECIFIC PROGNOSTIC
FACTORS
Definition: “A prognostic factor serves as a
variable that can explain some of the
heterogeneity associated with the expected
course and outcome of a disease.”
Harrington, et al. Introduction to Cancer Biology, in
Tannock IF, Hill RP, Bristow RG, Harrington L (eds).
The Basic Science of Oncology, 4th ed. New York, NY:
McGraw Hill; 2005:1-3
SITE SPECIFIC PROGNOSTIC
FACTORS



TUMOR FACTORS
Stage, Grade, Histology, Hormone Receptors
Biochemical markers, lymphovascular invasion,…
HOST FACTOR
Co-morbidity, Ethnicity, Smoking, Gender, Family
History, Genetic Predisposition, Immune Status,
Nutritional Status, Age,…
ENVIRONMENTAL FACTORS
Socioeconomic status, Access to care, Health
policy, Adequacy of Surgery,…
FUTURE OF STAGING


Interfacing anatomic staging with nonanatomic
prognostic factors
Newer diagnostic methods being introduced may
allow more accurate staging
Reference: Greene FL, Sobin LH. The Staging of Cancer: A Retrospective
and Prospective Appraisal. CA A Cancer Journal for Clinicians2008;58:180-190.