Radiation Oncology/Sarcoma/Staging
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Sarcoma Staging
AJCC 7th Edition (2009)
Primary Tumor:
- T1 - less than or equal to 5cm
- T1a - superficial
- T1b - deep
- T2 - greater than 5cm
- T2a - superficial
- T2b - deep
Regional Lymph Nodes:
- N0 - no
- N1 - yes
Distant Metastases:
- M0 - none
- M1 - yes
Grade:
- AJCC now recommends a three-tier system. The FNCLCC (French) system is the preferred grading system.
- The grade is determined by three parameters:
- Differentiation
- Mitotic activity
- Extent of necrosis
Stage Grouping:
- IA - T1a/b N0 G1 - low grade (grade 1), small
- IB - T2a/b N0 G1 - low grade (grade 1), large
- IIA - T1a/b N0 G2-3 - mod/high grade (grade 2-3), small
- IIB - T2a/b N0 G2 - mod grade (grade 2), large
- III - T2a/b G3, or N1 - high grade (grade 3), large; or node positive
- IV - M1 - metastatic
Changes from AJCC 6th Edition:
- Now incorporates a three-tiered grading system. For staging, there is now a distinction between G2 and G3, at least for tumors >5 cm.
- N1 is now Stage III instead of Stage IV
- Stage I is divided into IA and IB. Stage II is divided into IIA and IIB.
- Deep or superficial location of tumor no longer is a factor in overall stage
Notes:
- This staging system does not apply to Kaposi's sarcoma, GIST (is now staged with its own classification), fibromatosis (desmoid tumor), and infantile fibrosarcoma; does not apply to sarcomas arising in the dura mater or brain, parenchymal organs, and hollow viscera.
- Now includes dermatofibrosarcoma protuberans (which was previously excluded), angiosarcoma, and extraskeletal Ewing's sarcoma
- Superficial - located entirely in the subcutaneous tissues without any degree of any involvement of the muscular fascia or underlying muscle
Older systems
[edit | edit source]AJCC 6th Edition (2002)
- T1 - less than or equal to 5cm
- T1a - superficial
- T1b - deep
- T2 - greater than 5cm
- T2a - superficial
- T2b - deep
Stage Grouping:
- Stage I - All low grade, N0, M0
- Stage II - T1a/b-T2a, N0, high grade
- Stage III - T2b, N0, high grade
- Stage IV - N1 or M1, any grade
Note:
- Excludes dermatofibrosarcoma protuberans. Also excludes Kaposi's, fibromatosis (desmoid tumor), sarcoma arising from dura mater, brain, parenchymal organs, and hollow viscera.
AJCC 5th Edition (1997)
- Stage IA - low grade, small
- Stage IB - low grade, large and superficial
- Stage IIA - low grade, large and deep
- Stage IIB - high grade, small and deep
- Stage IIC - high grade, large, superficial
- Stage III - high grade, large, deep
- Stage IV - positive nodes or distant mets
AJCC 1st edition (1975-77)
- T3 is bone, major nerve, or vessel involvement
- Stage I - all grade 1
- Stage II - all grade 2
- Stage III - all grade 3, or T3