Radiation Oncology/Staging

From Wikibooks, open books for an open world
< Radiation Oncology
Jump to: navigation, search

The purpose of this page is to provide a quick comparison of the stages that are used for various malignancies. It is not meant to go into detail of what constitutes each stage. For that information, see the article on each specific malignancy.

This page uses the lastest AJCC 6th edition from 2002.

Note: should move this information into table form

Notes: M-stage not listed unless it is different than the commonly used M0 or M1.
For simplicity, N(1-3) means N-stage can be N0 or N1-3. However, N(0-1) means N-stage is N0 or N1. These schemes are different but easier to remember.
All sites also contain T0 (no tumor) but this isn't listed below. Many sites contain Tis and Stage 0 but these aren't listed below.

The headings below are per the AJCC Cancer Staging Handbook and do not necessarily follow the Table of Contents organization of this wikibook.

See also: TNM by organ categories - excellent web-based staging guide


AJCC Staging Editions[edit]

Return to Top

Current edition: 7th edition, 2009

  • Listing of editions: First date is the date of release; date range in parentheses is the date of use. Usually the edition is referred to my the year of release rather than the first year of use -- e.g. 5th edition (1997)
  • 1st edition: 1977 (1978-83), Cancer Staging Manual by the AJC
  • 2nd edition: 1983 (1984-88), Manual for Staging of Cancer
  • 3rd edition: 1988 (1989-1992) - PDF of AJCC 3rd ed
  • 4th edition: 1992 (1993-1997)
  • 5th edition: 1997 (1998-2002)
  • 6th edition: 2002 (2003-2009) - PDF of AJCC 6th ed (staging forms only)
  • 7th edition: 2009 (2010-)

Full text (PDF) of past editions (1st-5th) [1]

See also:

The AJCC was organized in 1959 as the American Joint Committee for Cancer Staging and End-Results Reporting (AJC). Its name was changed to American Joint Committee on Cancer (AJCC) in 1980.

Head and Neck[edit]

Return to Top

Note: Overall staging the same for all except nasopharynx and thyroid.
N-stage is the same for all (except the above 2). T-stage is similar for all subsites, with only minor differences.

  • Overall staging: I (T1 N0) - II (T2 N0) - III (T3 N0, T1-3 N1) - IVA (T4a, N2) IVB (T4b, N3) IVC (M1)
  • Lip and Oral Cavity - I - II - III - IVA IVB IVC
    T(T1-4 and T4a, T4b), N(N1, N2a N2b N2c, N3)
  • Oropharynx - I - II - III - IVA IVB IVC
    T(T1-4 and T4a, T4b), N(N1, N2a N2b N2c, N3)
  • Hypopharynx - I - II - III - IVA IVB IVC
    T(T1-4 and T4a, T4b), N(N1, N2a N2b N2c, N3)
  • Nasopharynx - I - II - III - IVA IVB IVC
    T(T1, T2a T2b, T3, T4), N(N1, N2, N3a N3b)
  • Larynx - I - II - III - IVA IVB IVC
    supraglottis and subglottis: T(T1, T2, T3, T4a T4b)
    glottis: T(T1a T1b, T2, T3, T4a T4b)
    for all: N(N1, N2a N2b N2c, N3)
  • Nasal cavity and paranasal sinuses - I - II - III - IVA IVB IVC
    T(T1-4 and T4a, T4b), N(N1, N2a N2b N2c, N3)
  • Salivary glands - I - II - III - IVA IVB IVC
    T(T1-4 and T4a, T4b), N(N1, N2a N2b N2c, N3)
    I (T1 N0) - IIA (T2a N0) IIB (T1-2 N1, T2b N0) - III (T3 N0-2, T1-3 N2) - IVA (T4 N0-2) IVB (N3) IVC (M1)
  • Thyroid
    Overall stage: papillary or follicular: (Under 45 years) I - II. (45 yrs+) I - II - III - IVA IVB IVC
    Overall stage: medullary: I - II - III - IVA IVB IVC
    Overall stage: anaplastic: IVA IVB IVC
    T(T1-4 and T4a, T4b), N(N1a and N1b). Anaplastic is T4a or T4b only.

Gastrointestinal[edit]

Return to Top

  • Note: These sites (the next 6) are all different with no pattern.
  • Esophagus - I - IIA IIB - III - IVA IVB
    T(1-4), N(0-1), M(0, 1a 1b) - M1a not applicable for midthoracic primary tumors
    I (T1 N0) - IIA (T2-3 N0) IIB (T1-2 N1) - III (T3N1 or T4) - IVA (M1a) IVB (M1b)
  • Stomach - IA IB - II - IIIA IIIB - IV
    T(T1, T2a T2b, T3, T4), N(1-3)
    IA (T1N0) IB (T1N1, T2N0) - II (T1N2, T2N1, T3N0) - IIIA (T2N2, T3N1, T4N0) IIIB (T3N2) - IV (T4N1-3, N3, M1)
    Mnemonic - IA add to 1, IB add to 2, II - 3, IIIA - 4, IIIB - 5
  • Small intestine - I - II - III - IV
    T(1-4), N(0-1)
    I (T1-2 N0) - II (T3-4 N0) - III (N1) - IV (M1)
  • Appendix (carcinoma) - I - IIA IIB IIC - IIIA IIIB IIIC - IVA IVB IVC
    T(1-4,4ab), N(0-2), M(0,1a/b)
    I (T1-2 N0) - IIA (T3 N0) IIB (T4a N0) IIC (T4b N0) - IIIA (T1-2 N1) IIIB (T3-4 N1) IIIC (N2) - IVA (N0 M1a G1) IVB (N0 M1a G2-3,N+ M1a) IVC (M1b)
  • Appendix carcinoid - I - II - III - IV
    T(1-4,1ab), N(0-1)
    I (T1 N0) - II (T2-3 N0) - III (T4 or N1) - IV (M1)
  • Carcinoid (non-appendiceal) - I - IIA IIB - IIIA IIIB - IV
    T(1-4),N(0-1)
    I (T1 N0) - IIA (T2 N0) IIB (T3 N0) - IIIA (T4 N0) IIIB (N1) - IV (M1)
  • Colon and rectum - I - IIA IIB - IIIA IIIB IIIC - IV
    T(1-4), N(1-2)
    I (T1-2 N0) - IIA (T3 N0) IIB (T4 N0) - IIIA (T1-2 N1) IIIB (T3-4 N1) IIIC (N2) - IV (M1)
  • Anal canal - I - II - IIIA IIIB - IV
    T(1-4), N(1-3)
    I (T1 N0) - II (T2-3 N0) - IIIA (T1-3 N1, T4 N0) IIIB (T4 N1, N2-3) - IV (M1)
  • Gastrointestinal Stromal Tumor (GIST)
    T(1-4), N(0-1). Mitotic rate: Low or High
    Gastric GIST: IA IB - II - IIIA IIIB - IV
    Gastric GIST: IA (T1-2 N0, low mit.) IB (T3 N0, low mit.) - II (T1-2 N0, high mit.; T4 N0, low mit.) - IIIA (T3 N0, high mit.) IIIB (T4 N0, high mit.) - IV (N1 or M1)
    Small Intestinal GIST: I - II - IIIA IIIB - IV
    Small Intestinal GIST: I (T1-2 N0, low mit.) - II (T3 N0, low mit.) - IIIA (T1 N0, high mit; T4 N0, low mit) IIIB (T2-T4 N0, high mit.) - IV (N1 or M1)
  • Liver - I - II - IIIA IIIB IIIC - IVA IVB
    T(1-4), N(0-1)
    I (T1 N0) - II (T2 N0) - IIIA (T3a N0) IIIB (T3b N0) IIIC (T4 N0) - IVA (N1) IVB (M1)
  • Gallbladder - I - III - IIIA IIIB - IVA IVB
    T(1a 1b, 2, 3, 4), N(0-2)
    I (T1 N0) - II (T2 N0) - IIIA (T3 N0) IIIB (T1-3 N1) - IVA (T4 N0-1) IVB (N2 or M1)
  • Extrahepatic bile ducts
    • Perihilar bile ducts - I - II - IIIA IIIB - IVA IVB
      T(1,2a/b,3,4), N(0-2)
      I (T1 N0) - II (T2a-b N0) - IIIA (T3 N0) IIIB (T1-3 N1) - IVA (T4 N0-1) IVB (N2 or M1)
    • Distal bile duct - IA IB - IIA IIB - III - IV
      T(1-4), N(0-1)
      IA (T1 N0) IB (T2 N0) - IIA (T3 N0) IIB (T1-3 N1) - III (T4) - IV (M1)
  • Intrahepatic bile ducts - I - II - III - IVA IVB
    I (T1 N0) - II (T2 N0) - III (T3 N0) - IVA (T4 N0, Any N1) IVB (M1)
  • Ampulla of Vater - IA IB - IIA IIB - III - IV
    T(1-4), N(0-1)
    IA (T1 N0) IB (T2 N0) - IIA (T3 N0) IIB (T1-3 N1) - III (T4) - IV (M1)
  • Pancreas - IA IB - IIA IIB - III - IV
    T(1-4), N(0-1)
    IA (T1 N0) IB (T2 N0) - IIA (T3 N0) IIB (T1-3 N1) - III (T4) - IV (M1)

Lung[edit]

Return to Top

  • Lung - IA IB - IIA IIB - IIIA IIIB - IV
    T(1a,1b,2a,2b,3-4), N(1-3)
    IA (T1 N0) IB (T2 N0) - IIA (T1 N1) IIB (T2 N1, T3 N0) - IIIA (T3 N1-2, T1-3 N2) IIIB (T4, N3) - IV (M1)
  • Pleural mesothelioma - IA IB - II - III - IV
    T(T1a T1b, T2, T3, T4), N(1-3)
    IA (T1a N0) IB (T1b N0) - II (T2 N0) - III (T1-2 N1-2, T3 N0-2) - IV (T4, N3, M1)

Musculoskeletal[edit]

Return to Top

  • Bone - IA IB - IIA IIB - III - IVA IVB
    T(1-3), N(0-1), M(1a, 1b). Grade is also used to determine stage.
    IA (T1 N0, Low grade) IB (T2 N0, Low grade) - IIA (T1 N0, High grade) IIB (T2 N0, High grade) - III (T3 N0) - IVA (M1a) IVB (N1, M1b)
  • Soft tissue sarcoma - I - II - III - IV
    T(1a 1b, 2a 2b), N(0-1). Grade is also used to determine stage.
    I (Low grade N0) - II (High grade T1a/b-T2a N0) - III (High grade T2b N0) - IV (N1, M1)

Skin[edit]

Return to Top

  • Carcinoma of the skin - I - II - III - IV
    T(1-4), N(1,2a/b/c,3)
    I (T1 N0) - II (T2 N0) - III (T3 N0, T1-3 N1) - IV (N2-N3 or T4 or M1)
  • Merkel cell carcinoma - IA IB - IIA IIB IIC - IIIA IIIB - IV
    T(1-4), N(0,1a/b,2)
    IA (T1 pN0) IB (T1 cN0) - IIA (T2-3 pN0) IIB (T2-3 cN0) IIC (T4 N0) - IIIA (N1a) IIIB (N1b/N2) - IV (M1)
  • Melanoma - Clinical node staging: IA IB - IIA IIB - III - IV - Pathologic node staging: IIIA IIIB IIIC
    T(1a 1b, 2a 2b, 3a 3b, 4a 4b), N(1a 1b, 2a 2b 2c, 3), M(1a 1b 1c). Note: all M1 are the same overall stage.
    Clinical - IA (T1a N0) IB (T2a, T1b N0) - IIA (T3a, T2b N0) IIB (T4a, T3b N0) IIC (T4b N0) - III (N+) - IV (M1)
    Pathologic - IIIA (N1a or N2a with no ulceration T1-4a) IIIB (N1b or N2b or N2c with no ulceration T1-4a, or N1a or N2a with ulceration T1-4b) IIIC (N1b or N2b or N2c with ulceration T1-4b,or any N3)
    Hint: ulceration always upstages by one

Breast[edit]

Return to Top

  • Breast - IA IB - IIA IIB - IIIA IIIB IIIC - IV
    T(1mic 1a 1b 1c, 2, 3, 4a 4b 4c 4d), N(1mi 1a 1b 1c, 2a 2b, 3a 3b 3c), M(0,cM0(i+),1). Note: all subtypes of a stage are the same overall stage.
    IA (T1 N0) IB (T0-1 N1mi) - IIA (T1 N1, T2 N0) IIB (T2 N1, T3 N0) - IIIA (N2, T3 N1) IIIB (T4) IIIC (N3) - IV (M1)

Gynecologic[edit]

Return to Top

In all, T-stage parallels the FIGO stage, except there is no T4b (Stage IVB is M1), and in cases where the FIGO stage includes node-positive disease as a distinct stage (e.g. uterine corpus Stage IIIC). Except for vulvar, N+ makes the overall stage the highest Stage III stage. There is no T4 (and thus no IVA) for ovary and fallopian tube.
N-stage changes the FIGO stage in most, but only in vulvar cancer is there N1 vs N2.

  • Vulva - IA IB - II - IIIA IIIB IIIC - IVA IVB (FIGO staging)
    T(1a 1b, 2, 3), N(1a 1b, 2a 2b 2c, 3)
    IA (T1a N0) IB (T1b N0) - II (T2 N0) - IIIA (T1-2 N1) IIIB (T1-2 N2a-b) IIIC (T1-2 N2c) - IVA (T3 or N3) IVB (M1)
  • Vagina - I - II - III - IVA IVB (FIGO staging)
    T(1-4), N(0-1). N+ is Stage III.
  • Cervix - IA1 IA2 IB1 IB2 - IIA1 IIA2 IIB - IIIA IIIB - IVA IVB (FIGO staging)
    T(1a1 1a2 1b1 1b2, 2a1 2a2 2b, 3a 3b, 4), N(0-1). N+ is Stage IIIB in AJCC only, not used in FIGO stage.
  • Endometrial carcinoma - IA IB - II - IIIA IIIB IIIC1 IIIC2 - IVA IVB (FIGO staging)
    T(1a 1b, 2, 3a 3b, 4), N(0-2)
    IA (T1a N0) IB (T1b N0) - II (T2 N0) - IIIA (T3a N0) IIIB (T3b N0) IIIC1 (T1-3 N1) IIIC2 (T1-3 N2) - IVA (T4) IVB (M1)
  • Uterine sarcoma - IA IB IC - II - IIIA IIIB IIIC - IVA IVB
    T(1a 1b 1c, 2, 3a 3b, 4), N(0-1)
    IA (T1a N0) IB (T1b N0) IC (T1c N0) - II (T2 N0) - IIIA (T3a N0) IIIB (T3b N0) IIIC (T1-3 N1) - IVA (T4) IVB (M1)
  • Ovary - IA IB IC - IIA IIB IIC - IIIA IIIB IIIC - IV (FIGO staging)
    T(1a 1b 1c, 2a 2b 2c, 3a 3b 3c), N(0-1). N+ is IIIC.
  • Fallopian tube - IA IB IC - IIA IIB IIC - IIIA IIIB IIIC - IV (FIGO staging)
    T(1a 1b 1c, 2a 2b 2c, 3a 3b 3c), N(0-1). N+ is IIIC.
  • Gestational trophoblastic tumors - IA IB - IIA IIB - IIIA IIIB - IVA IVB (FIGO staging)
    T(1-2), N stage is not used, M(1a 1b). Risk group (high or low or unknown) is also used in staging.

FIGO Staging[edit]

Return to Top

Links about FIGO staging.

Latest revision: 2009

See also: individual GYN chapters for FIGO staging references
  • 2009 PMID 19367689 -- "Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium." (Pecorelli S, Int J Gynaecol Obstet. 2009 May;105(2):103-4.)

Guidelines:

  • 2000 PDF "Staging Classifications and Clinical Practice

Guidelines for Gynaecological Cancers"

Genitourinary[edit]

Return to Top

  • Penis - I - II - IIIA IIIB - IV
    T(Ta, 1a 1b, 2-4), N(1-3)
    I (T1a N0) - II (T1b-T3 N0) - IIIA (T1-3 N1) IIIB (T1-3 N2) - IV (T4, N3, M1)
  • Prostate - I - IIA IIB - III - IV
    T(1a 1b 1c, 2a 2b 2c, 3a 3b, 4), N(0-1), M1(1a 1b 1c). Now incorporates PSA + Gleason score.
    I (T1-T2a N0 M0 PSA<10 G≤6) - IIA (T1-2 up to PSA<20 and G7) IIB (T1-2 PSA≥20 or G≥8 or T2c) - III (T3 N0) - IV (T4, N1, M1)
  • Testis - IA IB IS - IIA IIB IIC - IIIA IIIB IIIC (there is no Stage IV)
    T(1-4), N(1-3), M(1a 1b -- affects stage), S(1-3)
    IA (T1 N0 M0 S0) IB (T2-4 N0 M0 S0) IS (Any T N0 M0 S1-3) - IIA (Any T N1 M0 S0-1) IIB (Any T N2 M0 S0-1) IIC (Any T N3 M0 S0-1) - IIIA (Any T Any N M1a S0-1) IIIB (S2 and N1-3 or M1a) IIIC (S3 and N1-3 or M1a, or M1b)
  • Kidney - I - II - III - IV
    T(1a 1b, 2, 3a 3b 3c, 4), N(1-2). Substage does not change overall stage.
    I (T1 N0) - II (T2 N0) - III (T3, N1) - IV (T4, N2, M1)
  • Renal pelvis and ureter - I - II - III - IV
    T(1-4), N(1-3). Note: all N+ are the same overall stage.
    I (T1 N0) - II (T2 N0) - III (T3 N0) - IV (T4, N+, M1)
  • Bladder - 0a 0is - I - II - III - IV
    T(Ta Tis T1, 2a 2b, 3a 3b, 4a 4b), N(1-3). Substages 4a and 4b change overall stage but T2 and T3 substages do not. All N+ (N1-3) is the same overall stage.
    I (T1 N0) - II (T2 N0) - III (T3 N0, T4a N0) - IV (T4b, N+, M1)
  • Urethra - 0a 0is - I - II - III - IV
    T(Ta Tis, 1-4), N(1-2)
    I (T1 N0) - II (T2 N0) - III (T1-3 N1, T3 N0) - IV (T4, N2, M1)

Ophthalmic sites[edit]

Return to Top

Note: Rarely used

  • Retinoblastoma - No AJCC stage grouping
    Clinical: T(1a 1b, 2a 2b 2c, 3, 4), N(1-2), M(1a 1b)
    Pathologic: T(1, 2a 2b 2c, 3a 3b 3c, 4), N(0-1)

Central nervous system[edit]

Return to Top

No AJCC staging system

For more information on CNS tumors, see the CNS page

Lymphoid malignancies[edit]

Return to Top

TNM does not apply.

  • Lymphoma - Ann Arbor Stage: I - II - III - IV with modifiers.
  • Multiple myeloma - Durie-Salmon staging: IA IB - IIA IIB - IIIA IIIB.