The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. The stage often takes into account the size of a tumor, how deep it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to (if any), and whether it has spread to distant organs. Staging of cancer is important because the stage at diagnosis is the most powerful predictor of survival, and treatments are often changed based on the stage. Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... For malignant tumors specifically, see cancer. ... An organ is the following: In anatomy, an organ is a group of tissues which perform some function. ... Lymph nodes are components of the lymphatic system. ... For the musical composition, see Metastasis (Xenakis composition). ...

The TNM Staging system

It has been suggested that multiple sections of TNM staging be merged into this article or section. (Discuss)

Cancer staging can be divided into a clinical stage and a pathologic stage. In the TNM (Tumor, Node, Metastasis) system, clinical stage and pathologic stage are denoted by a small 'c' or 'p' before the stage, e.g. cT3N1M0 or pT2N0. Image File history File links Mergefrom. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...

• Clinical stage is based on all of the available information obtained before a surgery to remove the tumor. Thus, it may include information about the tumor obtained by physical examination, radiologic examination, and endoscopy.
• Pathologic stage adds additional information gained by examination of the tumor microscopically by a pathologist.

Because they use different information, clinical stage and pathologic stage are often different. Pathologic staging is usually considered the "better" or "truer" stage because it allows direct examination of the tumor and its spread, contrasted with clinical staging which is limited by the fact that the information is obtained by making indirect observations at a tumor which is still in the body. However, clinical staging and pathologic staging should complement each other. Not every tumor is treated surgically, so sometimes pathologic staging is not available. Also, sometimes surgery is preceded by other treatments such as chemotherapy and radiation therapy which shrink the tumor, so the pathologic stage may underestimate the true stage. “Surgeon” redirects here. ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Image A: A normal chest X-ray. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Chemotherapy is the use of chemical substances to treat disease. ... Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ...

Considerations in staging

Correct staging is critical because treatment is directly related to disease stage. Thus, incorrect staging would lead to improper treatment, and material diminution of patient survivability. Correct staging, however, can be difficult to achieve. Pathologic staging, where a pathologist examines sections of tissue, can be particularly problematic for two specific reasons: visual discretion and random sampling of tissue. "Visual discretion" means being able to identify single cancerous cells intermixed with healthy cells on a slide. Oversight of one cell can mean misstaging and lead to serious, unexpected spread of cancer. "Random sampling" refers to the fact that lymph nodes are cherry-picked from patients and random samples are examined. If cancerous cells present in the lymph node happen not to be present in the slices of tissue viewed, incorrect staging and improper treatment can result. Biological tissue is a group of cells that perform a similar function. ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the... Lymph nodes are components of the lymphatic system. ...

New, highly sensitive methods of staging are in development. For example, the mRNA for GCC (guanylyl cyclase C), present only in the luminal aspect of intestinal epithelium, can be identified using molecular screening (RT PCR) with an astonishing degree of sensitivity and exactitude. Presence of GCC in any other tissue of the body represents colorectal metaplasia. Because of its exquisite sensitivity, RT PCR screening for GCC nearly eliminates the possibility of underestimation of true disease stage. Researchers hope that staging with this level of precision will lead to more appropriate treatment and better prognosis. Furthermore, researchers hope that this same technique can be applied to other tissue-specific proteins. The interaction of mRNA in a eukaryote cell. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ...

Systems of staging

Staging systems are specific for each type of cancer (e.g. breast cancer and lung cancer). Some cancers, however, don't have a staging system. Often competing staging systems exist for the same type of cancer; however, the universally-accepted staging system is that of the UICC, which has the same definitions of individual categories as the AJCC. Breast cancer is cancer of breast tissue. ... Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. ... The International Union Against Cancer (UICC or Union Internationale contre le Cancer) is an organization associated with cancer research, awareness, and training. ... The American Joint Committee on Cancer (AJCC) is an organization best known for defining and popularizing cancer staging standards. ...

Systems of staging may differ between diseases or specific manifestations of a disease. (In cases where the main Wikipedia article has a specific section on staging, that section has been linked below.)

Blood

• Lymphoma: uses Ann Arbor staging

• Hodgkin's Disease: follows a scale from I-IV and can be indicated further by an A or B, depending on whether a patient is unsymptomatic or has symptoms such as fevers. It is known as the "Cotswold System" or "Modified Ann Arbor Staging System". [1]

This article is about lymphoma in humans. ... Ann Arbor staging is the staging system for lymphomas, both in Hodgkins lymphoma (previously called Hodgkins Disease) and Non-Hodgkin lymphoma (abbreviated NHL). ... Hodgkins disease is a type of lymphoma described by Thomas Hodgkin in 1832, and characterized by the presence of Reed-Sternberg cells. ...

Solid

For solid tumors, TNM is by far the most commonly used system, but it has been adapted for some conditions.

• Breast cancer: Uses TNM [2]

• Cervical and ovarian cancers: uses "FIGO" (similar to TNM). For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading system is used. [3]

• Colon cancer: originally consisted of four stages: A, B, C, and D (the Dukes staging system). More recently, colon cancer staging is indicated either by the original A-D stages or by TNM. [4]

• Kidney cancer: uses TNM [5]

• Cancer of the larynx: Uses TNM [6]

• Liver cancer: uses Stages I-IV [7]

• Lung cancer: uses TNM [8] or [9]

• Melanoma: TNM used. Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion ("Microstaging"). [10]

• Prostate cancer: outside of US, TNM almost universally used. Inside US, Jewett-Whitmore sometimes used. [11].

• Non melanoma skin cancer: uses TNM [12]

• Bladder cancer: uses TNM [13]

Breast cancer is cancer of breast tissue. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Cervical cancer is a malignant cancer of the cervix. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Cervical intraepithelial neoplasia, or CIN, is the abnormal growth of precancerous cells in the cervix. ... Diagram of the stomach, colon, and rectum Colorectal cancer includes cancerous growths in the colon, rectum and appendix. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Renal cell carcinoma, a form of kidney cancer that involves cancerous changes in the cells of the renal tubule, is the most common type of kidney cancer in adults. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Cancer of the larynx also may be called laryngeal cancer. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Hepatic tumors are tumors or growths on or in the liver (medical terms pertaining to the liver often start in hepato- or hepatic from the Greek word for liver, hepar). ... Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Prostate cancer staging is the process by which physicians evaluate the spread of prostate cancer. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Skin cancer is a malignant growth on the skin which can have many causes. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Bladder cancer refers to any of several types of malignant growths of the urinary bladder. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...

Overall stage grouping

Overall Stage Grouping is also referred to as Roman Numeral Staging. This system uses numerals I, II, III, and IV (plus the 0) to describe the progression of cancer. Roman numerals are a numeral system originating in ancient Rome, adapted from Etruscan numerals. ...

• Stage 0 carcinoma in situ.
• Stage I cancers are localized to one part of the body.
• Stage II cancers are locally advanced, as are Stage III cancers. Whether a cancer is designated as Stage II or Stage III can depend on the specific type of cancer; for example, in Hodgkin's Disease, Stage II indicates affected lymph nodes on only one side of the diaphragm, whereas Stage III indicates affected lymph nodes above and below the diaphragm. The specific criteria for Stages II and III therefore differ according to diagnosis.
• Stage IV cancers have often metastasized, or spread to other organs or throughout the body.

Within the TNM system, a cancer may also be designated as recurrent, meaning that it has appeared again after being in remission or after all visible tumor has been eliminated. Recurrence can either be local, meaning that it appears in the same location as the original, or distant, meaning that it appears in a different part of the body. Carcinoma in situ is present when a tumor has been detected that has the characteristics of malignancy but has not invaded other tissues. ... Hodgkins disease is a type of lymphoma described by Thomas Hodgkin in 1832, and characterized by the presence of Reed-Sternberg cells. ...

TNM staging

TNM Staging is used for solid tumors, and is an acronym for the words Tumor, Nodes, and Metastases. Each of these criteria is separately listed and paired with a number to indivate the TNM stage. A T1N2M0 cancer would be a cancer with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body). TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ...

• Tumor (T) refers to the primary tumor and carries a number of 0 to 4.
• N represents regional lymph node involvement and can also be ranked from 0 to 4.
• Metastasis is represented by the letter M, and is 0 if no metastasis has occurred or 1 if metastases are present.

Stage migration

Stage migration describes change in the distribution of stage in a particular cancer population induced by either a change in the staging system itself or a change in technology which allows more sensitive detection of tumor spread and therefore more sensitivity in detecting spread of disease (e.g. the use of MRI scan). Stage migration can lead to curious statistical phenomena. See Will Rogers phenomenon. The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... The Will Rogers phenomenon is obtained when moving an element from one set to another set raises the average values of both sets. ...

External links

• "Staging: Questions and Answers" at the National Cancer Institute
• http://www.uicc.org/index.php?id=508
• www.Lung-Cancers.net is a semi-automatic lung cancer staging tool and provides comprehensive information about chest malignancies