Tumour Staging Systems

Tumour staging systems are internationally agreed graduated classifications of tumour spread. All the tumour staging systems incorporate common principles:

• There is a graduation from ' early' confined tumours which are given low numbers in the classification systems, to 'late ' more advanced and widespread tumours which are given higher numbers in the classification systems. The presence and extent of lymph node metastases are treated similarly. Visceral and bone metastases are grouped in a general metastasis category but are not quantified.

• Each primary tumour has an individual staging classification tailored to its pattern of spread. The difference between tumour extent for each stage is clearly demarcated.

• The systems must be easily applied, forming a shorthand summary of the tumour extent, which is understood within the national and international cancer community.

• The precise information supplied must be of relevance to therapeutic decision-making.

• The staging systems are an indicator of likely prognosis since each step within the system correlates with worsening outcome. In oncology practice additional benefits accrue from cancer staging systems:

• The efficacy of new treatments can be assessed in similarly staged, and therefore, standardised populations.

• The performance of cancer treatment centres can be compared nationally and internationally.

• The exchange of information is facilitated between different cancer organisations.

The most commonly used staging system is the Tumour Node Metastasis (TNM) classification, which has common stratification groups for each tumour type. The TNM cancer staging classifications are reviewed regularly by the International Union against Cancer (Union Internationale Contre le Cancer, UICC) with contributions from associated national and international organisations. The American classification is the 'AJCC Cancer Staging Manual' produced by the American Joint Committee on Cancer and it correlates exactly with the TNM classification. Additional staging systems are in existence, which usually have fewer stratification groups. In gynaecological malignancy, the main alternate staging system is the Federation Internationale Gynécologie et Obstétrique (FIGO) classification. Bladder cancer may also be staged according to the Jewett-Strong-Marshall classification (principally in the USA). Colorectal cancer is commonly staged by the Duke's classification (principally in the UK).

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