Overview
Systematic cancer staging is crucial for determining appropriate treatment strategies and prognosis. This guide outlines the standard protocol for staging various types of cancer using the TNM classification system.
Pre-Staging Requirements
Essential Documentation
- Complete patient history
- Physical examination findings
- Relevant imaging studies
- Pathology reports
- Laboratory test results
Required Imaging Studies
- CT scan with contrast
- MRI (when indicated)
- PET scan (for specific cancer types)
- Bone scan (if metastasis suspected)
TNM Classification Process
Primary Tumor (T)
-
TX: Primary tumor cannot be assessed
-
T0: No evidence of primary tumor
-
Tis: Carcinoma in situ
-
T1-T4: Increasing size and/or local extent
Regional Lymph Nodes (N)
-
NX: Regional lymph nodes cannot be assessed
-
N0: No regional lymph node metastasis
-
N1-N3: Increasing involvement of regional lymph nodes
Distant Metastasis (M)
-
M0: No distant metastasis
-
M1: Distant metastasis present
Stage Grouping Protocol
-
Data Collection
- Review all diagnostic information
- Document TNM classifications
-
Stage Assignment
- Combine TNM findings
- Consult site-specific staging tables
- Document final stage (I-IV)
-
Additional Considerations
- Histologic grade
- Biomarker status
- Anatomic subsite
Documentation Requirements
Essential Elements
- Complete TNM classification
- Overall stage group
- Basis for staging (clinical vs. pathological)
- Date of staging
- Staging physician signature
Quality Assurance
Verification Steps
- Double-check all measurements
- Confirm imaging interpretations
- Verify pathology findings
- Review staging with tumor board when appropriate
Special Considerations
- Multiple primary tumors
- Recurrent disease
- Post-therapy staging
- Pediatric cancers
References
AJCC Cancer Staging Manual (current edition)