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223 Cards in this Set

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Endometrial FIGO Stages
IA, IB, II, IIIA, IIIB, IVA, IVB
Define endometrial stage IA
Tumor limited to endometrium or invades < 1/2 of the myometrium
Define endometrial stage IB
Tumor invasion one half or more of the myometrium
Define endometrial stage II
Invades stromal connective tissue of the cervix but does not extend beyond the uterus

Endocervical glandular involvement alone is considered stage I, not stage II
Define endometrial stage IIIA
Tumor invades serosa and/or adnexa (direct extension or metastasis)
Define endometrial stage IIIB
Vaginal involvement (direct extension or metastasis) or parametrial involvement
Define endometrial stage IIIC1 and IIIC2
Stage IIIC1: Pelvic LN metastases

Stage IIIC2: Paraaortic LN mets with or without pelvic LN metastates
Define endometrial stage IVA
Tumor invades the bladder and/or bowel mucosa

Bullous edema is not sufficient to classify a tumor as T4
Define endometrial stage IVB
Distant metastases
- Including intraperitoneal disease and/or metastases to inguinal LN, lung, liver, or bone
- Excludes metastases to PA LN, vagina, pelvis serosa, or adnexa
Endometrial cancer grades
% non-squamous or non-morular solid growth pattern

Note
1 Notable nuclear atypia, inappropriate for the architectural grade, raises the grade by one
2 Serous, clear cell, and mixed mesodermal tumors are Grade 3
Define endometrial grade 1
<= 5% of a nonsquamous or nonmorular solid growth pattern
Define endometrial grade 2
6-50% of a nonsquamous or nonmorular solid growth pattern
Define endometrial grade 3
> 50% of a nonsquamous or nonmorular solid growth pattern
Cervical FIGO Stages
0,
IA1, IA2, IB1, IB2,
IIA1, IIA2
IIB,
IIIA, IIIB,
IVA, IVB
Define cervical stage I
Carcinoma strictly confined to the cervix
(Extension to the corpus should be disregarded.)
Define cervical stage IA1 and IA2
Invasive cancer identified only microscopically.
All macroscopically visible lesions -- even with superficial invasion -- are stage IB cancers.

Invasion is limited to measured stromal invasion
IA1
- Maximum depth of 3.0 mm or less
- Horizontal spread 7.0 mm or less
IA2
- Stromal invasion at least 3.0 mm but not more than 5.0 mm
- Horizontal spread 7.0 mm or less
Define cervical stage IA1
Measured invasion of stroma <= 3.0 mm in depth and no wider than 7.0 mm
Define cervical stage IA2
Measured invasion of stroma > 3.0 mm and <= 5.0 mm and no wider than 7.0 mm
Define cervical stage IB
Clinical lesions confined to the cervix or preclinical lesions greater than stage IA
Define cervical stage IB1
Clinical lesions no greater than 4.0 cm
Define cervical stage IB2
Clinical lesions greater than 4.0 cm
Define cervical stage II
Invades beyond the cervix but not to pelvic wall or lower third of the vagina
Define cervical stage IIA
IIA1
IIA2
No obvious parametrial involvement
IIA1: Clinically visible lesion 4.0 cm or less
IIA2: Clinically visible lesion more than 4.0 cm
Define cervical stage IIB
Parametrial invasion
Define cervical stage III
Involves the lower third of the vagina and/or
Extends to the pelvic wall and/or
(No cancer-free space between the tumor and pelvic wall on rectal exam)
Causes hydronephrosis
Define cervival stage IIIA
Involves lower third of the vagina
No extension to the pelvic wall
Define cervical stage IIIB
Extends to the pelvic wall (T3b) and/or
Causes hydronephrosis or nonfunctioning kidney (T3b) and/or
Involves regional LN (N1)
Define cervical stage IVA
Invades mucosa of bladder or rectum and/or
Extends beyond the true pelvis

(Bullous edema is not sufficient to classify a tumor as T4)
Define cervical stage IVB
Distant metastasis
1 Peritoneal spread and/or
2 SCV or mediastinal nodes and/or
3 Lung, liver, or bone
Ovarian FIGO Stages
I: IA, IB, IC
II: IIA, IIB, IIC
III: IIIA, IIIB, IIIC
IV
Define ovarian stage I
Growth limited to the ovaries
Define ovarian stage IA
Growth limited to one ovary
No ascites
No tumor on the external surfaces
Capsule intact
Define ovarian stage IB
Growth limited to both ovaries
No ascites
No tumor on the external surfaces
Capsule intact
Define ovarian stage IC
Tumor either stage IA or IB but on the surface of one or both ovaries
Capsule ruptured
Ascites containing malignant cells present
Positive peritoneal washings
Define ovarian stage II
Growth involving one or both ovaries with pelvic extension of disease
Define ovarian stage IIA
Extension of disease and/or mets to the uterus and/or fallopian tubes
No malignant cells in ascites or washings
Define ovarian stage IIB
Extension to and/or implants on other pelvic tissues
No malignant cells in ascites or washings
Define ovarian stage IIC
Pelvis extension or implants (T2a or T2b) with malignant cells in ascites or washings
Define ovarian stage III
Tumor involving one or both ovaries with peritoneal implants outisde the pelvis and/or positive retroperitoneal or inguinal nodes
Superficial liver mets equals stage III
Tumor is limited to the true pelvis but with histologically verified malignant extension to the small bowel or omentum
Define ovarian stage IIIA
Microscopic peritoneal mets beyond pelvis but no macroscopic tumor
Define ovarian stage IIIB
Macroscopic peritoneal mets beyond pelvis not more than 2 cm in greatest dimension
Define ovarian stage IIIC
Abdominal implants > 2 cm and/or positive regional lymph nodes
Define ovarian stage IV
Distant mets excluding peritoneal mets
If pleural effusion is present, there must be positive cytologic test results to allot a case to stage IV.
Parenchymal liver mets
List prostate cancer stages
T1a, T1b, T1c
T2a, T2b, T2c
T3a, T3b
T4
N1
M1
Define prostate stage T1a
Tumor incidental histologic finding in ≤ 5% of resected tissue
Not palpable
Define prostate stage T1b
Tumor incidental histologic finding in > 5% of resected tissue
Define prostate stage T1c
Tumor identified by needle biopsy (eg, because of elevated PSA level)
Define prostate stage T2a
Tumor involves ≤ one-half of one lobe
Define prostate stage T2b
Tumor involves > one-half of one lobe but not both lobes
Define prostate stage T2c
Tumor involves both lobes
Define prostate stage T3a
Extracapsular extension (unilateral or bilateral)
Define prostate stage T3b
Tumor invades seminal vesicle(s)
Define prostate stage T4
Fixed to pelvic side wall
Invades adjacent structures other than seminal vesicles:
- Bladder neck
- External sphincter
- Rectum
- Levator muscles
- Pelvis wall
Define prostate stage N1
Positive regional lymph nodes
- Pelvic
- Hypogastric
- Obturator
- Iliac (internal or external)
- Sacral
-- Lateral
-- Presacral
-- Promontory (Gerota's)
Define prostate stage M1
Distant metastasis
M1a - Non-regional nodes
M1b - Bone
M1c - Other sites
List stages of vulvar cancer
T: X, 0, is, 1, 1a, 1b, 2, 3, 4
N: X, 0, 1, 2
M: X, 0, 1
Define vulvar stage TX
Primary tumor cannot be assessed
Define vulvar stage T0
No evidence of primary tumor
Define vulvar stage Tis
Carcinoma in situ
(preinvasive carcinoma)
Define T1
Tumor confined to the vulva or vulva and perineum
2 cm or less in greatest dimension
Defeine vulvar stage T1a/IA
Tumor confined to the vulva or vulva and perineum
2 cm or less in greatest dimension
Stromal invasion ≤ 1 mm
Define vulvar stage T1b/IB
Tumor confined to the vulva or vulva and perineum
≤ 2 cm in greatest dimension
Stromal invasion > 1 mm
Define vulvar stage T2/II
Tumor of any size with extension to adj perineal structures
- Distal 1/3 of urethra
- Distal 1/3 of vagina
- Anal involvement

TNM uses T2 while FIGO calls this T2/3
Define vulvar stage T3/IVA
Tumor of any size with extension to any of the following
- Proximal 2/3 of urethra
- Proximal 2/3 of vagina
- Bladder mucosa
- Rectal mucosa
- Fixed to pelvic bone

TNM uses T3 while FIGO calls this T4
Define vulvar stage T4
Tumor invades any of the following:
Upper urethral mucosa
Bladder mucosa
Rectal mucos
Fixed to the pubic bone
Define vulvar stage N1/FIGO IIIA
N1a/FIGO IIIA One or two LN mets each no more than 5 mm

N1b/FIGO IIIA One LN met more than 5 mm
Define vulvar stage N2/FIGO IIIB
N2a/FIGO IIIB Three or more LN mets no greater than 5 mm

N2b/FIGO IIIB Two or more LN mets greater than 5 mm

N2c/FIGO IIIC LN mets with ECE
List vulvar M stages
X, 0, 1
Define vulvar stage MX
Distant mets cannot be assessed
Define vulvar stage M1
Distant mets including pelvic lymph node mets
List the vulvar FIGO stage grouping
Stage 0, IA, IB, II, III, IVA, IVB
Define vulvar FIGO stage 0
Tis N0 M0
Define vulvar FIGO stage IA
T1a N0 M0
Define vulvar FIGO stage IB
T1b N0 M0
Define vulvar FIGO stage II
T2 N0 M0
Define vulvar FIGO stage IIIA
T1-2 N1a-N1b M0
Define vulvar FIGO stage IVA
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4 Any N M0
Define vulvar FIGO stage IVB
Any T Any N M1
Basic Concepts of STS Staging
AJCC staging system
-Unique among AJCC staging systems
-High importance of grade for prognosis
-Three prognostic factors
1 Tumor size
2 Tumor grade
3 Tumor depth
STS TNM
TX Cannot be assessed
T0 No evidence of primary
T1 ≤5 cm
--T1a Superficial tumor
--T1b Deep tumor
T2 >5 cm
--T2a Superficial tumor
--T2b Deep tumor
N1 Regional LN mets
M1 Distant mets
STS Histopathologic grade
GX Grade cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated
STS Stage grouping
Stage I
A G1-2 T1a-1b N0 M0
B G1-2 T2a N0 M0
Stage II
A G1-2 T2b N0 M0
B G3-4 T1a-1b N0 M0
C G3-4 T2a N0 M0
Stage III G3-4 T2b N0 M0
Stage IV
-Any G Any T N1 M0
-Any G Any T N0 M1
Malignancy Group by Type of STS
Group 1
- Locally recurring neoplasms
- Little or no metastatic potential
Group 2
-Sarcomas of intermediate agressiveness
-But with metastatic capability
Group 3 - Aggressive sarcomas
Breast T1
T1mic Microinvasion ≤ 0.1 cm
T1a > 0.1 but ≤ 0.5 cm
T1b > 0.5 but ≤ 1 cm
T1c > 1 but ≤ 2 cm
Breast T2
> 2 but ≤ 5 cm
Breast T3
> 5 cm
Breast T4
T4a Extension to chest wall not including pectoralis
T4b
- Edema (peau d'orange) or ulceration of skin
- Satellite skin nodules confined to same breast
T4c Both T4a and T4b
T4d Inflammatory carcinoma
Breast N1
Mets to movable ipsi axillary nodes
Breast N2
N2a Mets in ipsi axillary nodes fixed or matted
N2b Mets in CA ipsi internal mammary nodes without CA axillary nodes
Breast N3
N3a Mets in ipsi infraclavicular nodes
N3b Mets in ipsi internal mammary and axillary nodes
N3c Mets in ipsi supraclvicular nodes
Breast pN1
pN1mi
> 0.2 mm but ≤ 2.0 mm
In 1-3 axillary nodes and/or IMNs by SLND not CA
pN1a Met in 1-3 axillary nodes
pN1b Mets in IMNs by SLND not CA
Breast N2
N2a Mets in 4-9 axillary nodes
N2b Mets in CA IMNs without axillary nodes
Breast N3
N3a Mets in ≥ 10 axillary nodes or mets to the infraclavicular nodes
N2b Mets in CA ipsi IMNs in the presence of ≥ 1 positive axillary nodes; in > 3 axillary nodes and in IMNs with microscopic disease by SLND but not CA
pN3c Mets in ipsilateral supraclavicular nodes
Breast Stage I
T1N0M0
Breast Stage IIA
T0-1 N1 M0
T2 N0 M0
Breast Stage IIB
T2 N1 M0
T3 N0 M0
Breast Stage IIIA
T0-2 N2 M0
T3 N1-2 M0
Breast Stage IIIB
T4 N0-2 M0
Breast Stage IIIC
Any T N3 Mo
Breast Stage IV
Any T Any N M1
Breast disease: multicentricity
Lesions in different quadrants --> mastectomy
Breast disease: multifocality
Lesions in same quadrant --> still option for BCT
Colon and Rectum T Stage
T1 Invades submucosa

T2 Invades muscularis propria

T3 Invades through muscularis propria into subserosa or into non-peritonealized pericolic or perirectal tissues

T4 Directly invades other organs or structures and/or perforaes visceral peritoneum
Colon and Rectum N Stage
N1 Mets in 1 to 3 regional nodes

N2 Mets in 4 or more regional nodes
Colon and Rectum M Stage
M1 Distant mets
Colon and Rectum Staging Grouping (Dukes)
I: T1N0M0, T2N0M0 (A)

IIA: T3N0M0 (B)

IIB: T4N0M0 (B)

IIIA: T1N1M0, T2N1M0 (C)

IIIB: T3N1M0, T4N1M0 (C)

IIIC: Any T N2M0 (C)

IV: Any T Any N M1
Immunophenotyping: CD45
All lymphoid cells
Immunophenotyping: CD19, CD 20, CD 22
B-cells
Immunophenotyping: CD2, CD3, CD 5, CD7
T-cells
Immunophenotyping
- CD4
- CD8
CD4: Helper T cells

CD8: Cytotoxic cells
Immunophenotyping: CD16, CD56, CD57
Natural killer cells
Immunophenotyping: CD5-, CD10+, CD43-
Follicular cell lymphoma
Immunophenotyping: CD5+, CD10+, CD43-
Mantle cell lymphoma
Immunophenotyping: CD5-, CD10-, CD23-
MALT lymphoma
Immunophenotyping: CD15+, CD30+
Hodgkin's disease
Cytogenetics: Alveolar rhabdomyosarcoma
T(2:13) and T(1:13)
Cytogenetics: Burkitt's lymphoma and B-cell ALL (c-myc gene)
t(8:14) and t(8:22)
Cytogenetics: Mantle cell lymphoma
(bcl-1 gene, cyclin D1 over expression)
t(11:14)
Cytogenetics: Ewing's sarcoma & PPNET
t(11:22)
Cytogenetics: Clear cell sarcoma
t(12:22)
Cytogenetics: Follicular lymphoma and diffuse large B-cell lymphoma (BCL-2 gene)
t(14:18)
Cytogenetics: CLL (BCL-3 gene)
t(14:19)
Cytogenetics: Synovical cell sarcoma
t(X:18)
Staging: Urethra - T Stages
Staging: Urethra - T Stages

T1 - Subepithelial tissue
T2
- Corpus spongiosum
- Prostate
- Periurethral muscle
T3
- Corpus cavernosum
- Beyond prostate capsule
- Anterior vagina
- Bladder neck
T4 - Other adjacent organs
Staging: Urethra - N Stages
Staging: Urethra - N Stages
N1 - Single node ≤ 2cm
N2
- Single node > 2cm
- Multiple nodes
Staging: Urethra - M Stages
Staging: Urethra - M Stages
M0 - No distant mets
M1 - Distant mets
Staging: Urethra - Group stages
Staging: Urethra - Group stages
I - T1N0M0
II - T2N0M0
III - T1N1, T2N1, T3N0, T3N1
IV - T4N0, T4N1, TxN2, TxNxM1
Staging: Urothelial (transitional cell) carcinoma of the prostate - T Stages
Staging: Urothelial (transitional cell) carcinoma of the prostate - T Stages
Tis pu - Cis prostatic urethra
Tis pd - Cis prostatic ducts
T1 - Subepithelial connective tissue
T2 - Prostatic stroma
- Corpus spongiosum
- Periurethral muscle
T3 - Corpus cavernosum
- Beyond prostatic capsule
- Bladder neck (extraprostatic extension)
T4 - Other adjacent organs (bladder)
Staging: Urothelial (transitional cell) carcinoma of the prostate - N Stages
Staging: Urothelial (transitional cell) carcinoma of the prostate - N Stages
N1 Single node ≤ 2cm
N2
- Single node > 2cm
- Multiple nodes
Staging: Urothelial (transitional cell) carcinoma of the prostate - M Stages
Staging: Urothelial (transitional cell) carcinoma of the prostate - M Stages

M0 No distant mets
M1 Distant mets
Staging: Urothelial (transitional cell) carcinoma of the prostate - Stage groups
Staging: Urothelial (transitional cell) carcinoma of the prostate - Stage groups

I: T1N0M0
II: T2N0M0
III
- T1N1M0
- T2N1M0
- T3N0M0
- T3N1M0
IV
- T4N0M0
- T4N1M0
- TxN2M0
- TxNxM1
Staging: Bladder - T Stages
Staging: Bladder - T Stages

Tis - Flat tumor
T1 - Subepithelial connective tissue
T2a - Invades superficial (inner half) muscle
T2b - Invades deep (outer half) muscle
T3a - Microscopic perivesical tissue
T3b - Macroscopic pervesical tissue (extravesical mass)
T4a - Prostate, uterus, vagina
T4b - Pelvic wall, abd wall
Staging: Bladder - N Stages
Staging: Bladder - N Stages

N1: Single node ≤ 2 cm
N2
- Single node > 2 cm but ≤ 5 cm
- Multiple nodes ≤ 5cm
N3: > 5cm
Staging: Bladder - M Stages
Staging: Bladder - M Stages

M0 - No distant mets
M1 - Distant mets
Staging: Bladder - Group stages
Staging: Bladder - Group stages

I: T1N0M0
II: T2a/bN0M0
III: T3a/bN0M0, T4aN0M0
IV
- T4bN0M0
- AnyT N1-3 M0
- AnyT AnyN M1
Staging: Testis - pT stages
Staging: Testis - pT stages
pTis - Intratubular germ cell neoplasia
pT1
- Testis and epididymis without LVSI
- Tunica albuginea but not vaginalis
pT2
- Testis and epididymis with LVSI
- Tunica albuginea and vaginalis
pT3 - Spermatic cord +/- LVSI
pT4 - Scrotum +/- LVSI
Staging: Testis - pN stages
Staging: Testis - N stages

pN1 ≤ 2cm and ≤ 5 pos nodes
pN2
- > 2 but ≤ 5 cm
- > 5 pos nodes ≤ 5cm
- ECE
pN3 > 5cm
Staging: Testis - cN stages
Staging: Testis - cN stages

cN1 - Single <= 2cm
- Multiple <= 2cm
cN2 - Single 2-5 cm
- Multiple with one 2-5cm
cN3 - > 5cm
Staging: Testis - M stages
Staging: Testis - M stages

M0 - No distant mets
M1a - Non-regional nodal or pulm mets
M1b - Distant mets other than non-regional and pulm
Staging: Testis - S stages
Staging: Testis - S stages
S0 - Markers normal
S1 - LDH < 1.5N AND
hCG < 5000mIu/ml AND
AFP < 1000ng/ml
S2 - LDH 1.5-10N OR hCG 5000-50,000mIu/ml OR AFP 1000-10,000ng/ml
S3 - LDH > 10N OR hCG > 50,000mIu/ml OR AFP > 10,000ng/ml
Staging: Testis - Groups stages IA
Staging: Testis - Groups stages IA

IA: pT1N0M0S0
IB: pT2-4N0M0S0
IS: pTxN0M0S1-3
IIA: pTxN1M0S0-1
IIB: pTxN2M0S0-1
IIC: pTxN3M0S0-1
IIIA: pTxNxM1aS0-1
IIIB: pTxNxM0S2 or pTxNxM1aS2
IVA: pTxNxM0S3 or pTxNxM1aS3 or pTxNXM1bSx
Staging: Esophagus - T stages
Staging: Esophagus - T stages

T1 - Lamina propria or submucosa
T2 - Muscularis propria
T3 - Adventitia
T4 - Adjacent structures
Staging: Esophagus - N stages
Staging: Esophagus - N stages

N0 - No regional nodes
N1 - Regional nodes
Staging: Esophagus - M stages
Staging: Esophagus - M stages
Lower thoracic esophagus
M1a - Mets in celiac nodes
M1b - Other distant mets
Midthoracic esophagus
M1a - Not applicable
M1b - Nonregional nodes or distant mets
Upper thoracic esophagus
M1a - Mets in cervical nodes
M1b - Other distant mets
Staging: Esophagus - Stage groups
Staging: Esophagus - Stage groups

I: T1N0M0
IIA: T2N0M0, T3N0M0
IIB: T1N1M0, T2N1M0
III: T3N1M0, T4NxM0
IVA: TxNxM1a
IVB: TxNxM1b
Staging: Esophagus - Regional nodes
Staging: Esophagus - Regional nodes
Cervical esophagus
- Scalene, IJ, cervical
- Periesophageal, supraclav
Intrathoracic (upper, mid, lower)
- Upper periesophageal (above azygous)
- Subcarinal, lower periesoph
GE junction
- Lower esoph, diaphragmatic
- Pericardial, left gastric, celiac
Staging: Penis - T stages
Staging: Penis - T stages

T1 - Subepithelial connective tissue
T2 - Corpus spongiosum or cavernosum
T3 - Urethral or prostate
T4 - Adjacent strucles
Staging: Penis - N stages
Staging: Penis - N stages

N1 - Single superficial inguinal node
N2
- Multiple superficial inguinal nodes ipsi or bilateral
N3 - Deep inguinal or pelvic lymph nodes uni- or bilateral
Staging: Penis - M stages
Staging: Penis - M stages

M0 No distant mets
M1 Distant mets
Staging: Anal T Stages
Staging: Anal T Stages

T1 ≤ 2 cm
T2 > 2 cm but ≤ 5cm
T3 > 5cm
T4: Adj organs
- Vagina
- Urethra
- Bladder

Direct invasion of rectall wall, perirectal skin, subcu tissue, or sphincter is not T4.
Staging: Anal N Stages
Staging: Anal N Stages

N1: Perirectal lymph nodes
N2
- Unilateral internal iliac nodes
- Unilateral inguinal nodes
N3
- Perirectal and inguinal nodes
- Bilateral internal iliac nodes
- Bilateral inguinal nodes
Staging: Anal M Stages
Staging: Anal M Stages

M1: Distant mets
Staging: Anal Group Staging
Staging: Anal Group Staging

I: T1N0M0
II: T2N0M0, T3N0M0
IIIA: T1N1M0, T2N1M0,T3N1M0,T4N0M0
IIIB: T4N1M0,TxN2M0,TxN3M0
IV: TxNxM1
Basic Concepts of STS Staging
Applies to all STS except
1 Kaposi's sarcoma
2 Dermatofibrosarcoma protuberans
3 Desmoid tumor
4 Sarcoma arising within the dura mater including the brain
5 Sarcomas arising within parenchymatous organs or hollow viscera
Depth defined in relation to superficial muscular fascia
If tumor involves superficial muscular fascia and retroperitoneal regions = deep
Vagina T1
Confined to vagina
Vagina T2
Invades paravaginal tissues but not to pelvic wall
Vagina T3
Extends to pelvic wall

Pelvic wall
- Muscle
- Fascia
- Neurovascular structures
- Skeletal portion of bony pelvis
Vagina T4
Invades rectal/bladder mucosa and/or
Extends beyond true pelvis
Vagina N1
Pelvic or inguinal lymph node mets
Vagina M1
Distant mets
Vagina FIGO Stages
I
II
III
IVA
IVB
Vagina FIGO Stages
I: T1N0M0
II: T2N0M0
III: T3N0M0, T1-3N1
IVA: T4 AnyN M0
IVB: AnyT AnyN M1
Define prostate histologies
Define prostate histologies
- Adenocarcinoma
- Squamous carcinomas
Not
- Sarcoma
- Transitional cell carcinoma = urethral tumor
Define prostate grades
Define prostate grades
G1: Well diff (Gleason 2-4)
G2: Mod diff (Gleason 5-6)
G3-4: Poorly diff/Undiff (Gleason 7-10)
Staging: Penis - Group Stages
Staging: Penis - Group Stages

I: T1N0M0
II: T1N1M0, T2N0-1M0
III: T1-2N2M0, T3N0-2M0
IV: T4 Any N M0, Any T N3 M0, Any T Any N M1
Stomach T Staging
T1: Lamina propria or submucosa
T2a: Muscularis propria
T2b: Subserosa
T3: Penetrates serosa without invasion of adj structures
T4: Adj structures
Stomach N Staging
N1: 1-6 regional nodes
N2: 7-15 regional nodes
N3: > 15 regional nodes
Not Stomach Regional Nodes = Distant Mets
Hepatoduodenal
Retropancreatic
Mesenteric
Para-aortic
Stomach Stage Grouping
IA: T1N0M0
IB: T1N1M0, T2a/bN0M0
II: T1N2M0, T2a/bN1M0, T3N0M0
IIIA: T2a/bN2M0, T3N1M0, T4N0M0
IIIB: T3N2M0
IV: T4N1-3M0, T1-3N3M0, TxNxM1
Small Intestine T Staging
T1: Lamina propria or submucosa
T2: Muscularis propria
T3: Penetrates muscularis propria
- Into subserosa
- Into nonperitonealized perimuscular tissues (mesentery or retroperitoneum) ≤ 2 cm
T4: Perforates visceral peritoneum
Directly invades other organs or structures
-- Other loops of small intestine
-- Mesentery
-- Retroperitoneum > 2 cm
-- Abdominal wall
-- Pancreas (for duodenum only)
Small Intestine N Staging
N1: Regional nodes
Small Intestine Group Staging
I: T1-2N0M0
II: T3-4N0M0
III: TxN1M0
IV: TxNXM1
Colorectal T Staging
T1: Submucosa
T2: Muscularis propria
T3
- Through muscular into subserosa
- Into non-peritonealized pericolic or perirectal tissues
T4
- Other organs or structures
- Perforates visercal peritoneum
Colorectal N Staging
N1: 1-3 regional nodes
N2: > 3 regional ndoes
Colorectal Dukes Staging
A
B
C
A: I
B: IIA and IIB
C: IIIA, IIIB, IIIC
Colorectal R Staging
R0
- Complete resection
- Margins histologically negative
- No residual tumor
R1
- Incomplete resection
- Margins histologically involved
- Microscopic residual tumor
R2
- Incomplete resection
- Margins involved
- Gross residual disease
Liver T Staging
T1: Solitary with VI
T2
- Solitary with VI
- Multiple tumors ≤ 5 cm
T3
- Multiple tumors > 5 cm OR
- Involving major branch of portal or hepatic veins
T4
- Direct invasion of adj organs other than GB OR
- Perforation of visceral peritoneum
Liver N Staging
N1: Regional nodes
Liver Stage Grouping
I: T1N0M0
II: T2N0M0
IIIA: T3N0M0
IIIB: T4N0M0
IIIC: TxN1M0
IV: TxNxM1
Gallbladder T Staging
T1a: Lamino propria
T1b: Muscle layer
T2
- Perimuscular connective tissue
- No extension beyond serosa or into liver
T3
- Perforates seros
- Invades liver or adj organ
T4
- Invades main portal vein or hepatic artery
- Invades ≥ 2 extrahepatic organs
Gallbladder N Staging
N1: Regional nodes
Extrahepatic Bile Duct T Staging
T1: Bile duct only
T2: Wall of duct
T3
- Liver, GB, or pancreas
- Ipsi branches of portal vein or hepatic artery
T4
- Main portal vein or branches bilaterally
- Common hepatic artery
- Adj structures
-- Colon
-- Stomach
-- Duodenum
-- Abdominal wall
Extrahepatic Bile Duct N Staging
N1: Regional nodes
Ampulla T Staging
T1: Ltd to ampulla or Oddi
T2: Duodenal wall
T3: Pancreas
T4: Peripan soft tissue or adj organs
Pancreas T Staging
T1: Ltd to pancreas ≤ 2 cm
T2: Ltd to pancreas > 2 cm
T3: Beyond pancreas but no celiac or SMA involvement
T4: Celiac or SMA involvement
Pancreas Stage Grouping
IA: T1N0M0
IB: T2N0M0
IIA: T3N0M0
IIB: T1-3N1M0
III: T4NxM0
IV: TxNXM1
Mesothelioma T Staging
T1a: Ipsi parietal pleura without visceral pleura
T1b: Ipsi parietal pleura with focal visceral pleura
T2: Ipsi parietal pleura and
- Confluent visceral pleura +/- diaphragm +/- lung parenchyma
T3: Ipsi pleural and
- Endothoracic fascia +/- mediastinal fat +/- solitary chest wall ST focus +/- non-transmural pericardium
T4: Ipsi pleural and
- Diffuse or multifocal chest +/- wall +/- any rib or spine +/- through diaphragm +/- any med organ +/- direct extension to contra pleura +/- internal pericardium or pericardial effusion positive +/- myocardium +/- brachial plexus
Mesothelioma N Staging
N1: Ipsi bronchopulm or hilar nodes
N2: Subcarinal nodes +/- ipsi IN or med nodes
N3
- Contra med, IMN, hilar nodes +/-
- Any supraclav or scalene nodes
Mesothelioma Stage Grouping
IA: T1aN0M0
IB: T1bN0M0
II: T2N0M0
III: T1-2N1M0, T1-2N2M0, T3N0-2M0
IV: T4NxM0, TxN3M0, TxNxM1
Bone T Staging
T1: ≤ 8 cm
T2: > 8 cm
T3: Discontinuous tumors
Bone Stage Grouping
IA: T1N0M0G1/2
IB: T2N0M0G1/2
IIA: T1N0M0G3/4
IIB: T2N0M0G3/4
III: T3N0M0Gx
IVA: TxN0M1aGx
IVB: TxN1MxGx, TxNxM1bGx
Bone G Staging
G1: Well diff/Low grade
G2: Mod diff/Low grade
G3: Poorly diff/High grade
G4: Undiff/High grade
Bone Histologies
1
2
3
4
5
6
7
8
1 Osteosarcoma
2 Chondrosarcoma
3 PNET/Ewing's sarcoma
4 Angiosarcoma
5 Fibrosarc/MFH
6 Chordoma
7 Adamantinoma
8 Other
Skin T Staging
T1: ≤ 2 cm
T2: 2 < X ≤ 5 cm
T3: > 5 cm
T4: Deep extradermal structures
- Cartilage
- Skeletal muscle
- Bone
Skin Stage Grouping
I: T1N0M0
II: T2-3N0M0
III: T4N0M0, TxN1M0
IV: TxNxM1
Melanoma T Staging
T1a ≤ 1.0 mm without ulceration
T1b ≤ 1.0 mm, level II or III, no ulceration
T2a 1.01-2 mm, no ulceration
T2b 1.01-2 mm with ulceration
T3a 2.01-4 mm no ulceration
T3b 2.01-4 mm with ulceration
T4a > 4.0 mm no ulceration
T4b > 4.0 mm with ulceration
Melanoma N Staging
N1a: Microscopic mets in one node
N1b: Macroscopic mets in one node
N2a: Micro mets in 2-3 nodes
N2b: Macroscopic miets in 2-3 nodes
N2c: Satellite or in-transit mets without nodal mets
N3
- Mets in > 3 nodes
- Matted nodes
- Intransit mets or satellites in regional nodes
Melanoma M Staging
M1a: Skin, subcu tissues, distant nodes
M1b: Lung
M1c
- `All other sites
- Distant mets with elevated LDH
Melanoma Stage Grouping
IA: T1aN0M0
IB: T1b/T2aN0M0
IIA: T2b/T3aN0M0
IIB: T3b/T4aN0M0
IIC: T4bN0M0
III: TxN1-3M0
IV: TxNxM1
Kidney T Staging
T1a ≤ 4 cm, ltd to kidney
T1b 4 < X ≤ 7 cm, ltd to kidney
T2 > 7 cm, ltd to kidney
T3a
- Major veins
- Adrenal or perinephric tissues
- Not beyond Gerota's fascia
T3b
- Renal vein or segmental branches
- Vena cava grossly below diaphragm
T3c
- Vena cava grossly above diaphgram
- Wall of vena cava
T4 Beyond Gerota's fascia
Kidney N Staging
N1: Single regional node
N2: > 1 regional node
Kidney Stage Grouping
I: T1N0M0
II: T2N0M0
III: T3N0M0, T1-3N1M0
IV: T4N0-1M0, TxN2M0, TxNxM1
Renal Pelvis/Ureter T Staging
T1: Subepithelial connective tissue
T2: Muscularis
T3
- Peripelvic fat (both)
- Renal parenchyma (renal pelvis only)
T4
- Adj organs
- Through kidney into perinephric fat
Renal Pelvis/Ureter N Staging
N1: Single node ≤ 2 cm
N2
- Single node 2 < X ≤ 5 cm
- Multiple nodes ≤ 5 cm
N3: > 5 cm
Renal Pelvis/Ureter Stage Grouping
I: T1N0M0
II: T2N0M0
III: T3N0M0
IV: T4N0M0, TxN1-3M0, TxNxM1
Eyelid T Staging
T1
- Any size without tarsal plate
- ≤ 5 mm at margin
T2
- Invades tarsal plate
- 5 < X ≤ 10 mm at margin
T3
- Full eyelid thickness
- > 10 mm at margin
T4 Adj structures
Eyelid Stage Grouping
None
Conjunctiva T Staging
T1: ≤ 5 mm
T2: > 5 mm without adj structures
T3: Adj structures except orbit
T4a: Orbital soft tissue without bone
T4b: Bone
T4c: Adj paranasal sinuses
T4d: Brain
Conjunctiva Stage Grouping
None
Lymphoid Staging
1 Site
2 Laterality
3 histopathologic type
4 Ann Arbor stage
1 Site: Nodal or extranodal
2 Laterality: Right, Left, Bilateral
3 Histo type: Working Formulation, REAL Classification, T-Cell/NK Neoplasms
4 Ann Arbor stage
Lymphoid Staging: Ann Arbor
I: Single nodal region
IE: Localized single extralymphatic organ without lymph node involvement
II: ≥ 2 lymph node regions on same side of diaphragm
IIE: Single exralymphatic organ with regional node involvement +/- other nodes on same side of diaphragm
III: Nodes on both sides of diaphragm
IIIE: Nodes on both sides +/- extralymphatic extension with adj nodes
IIIS: With spleen
IIIE,S: With extranodal and spleen
IV: Diffuse involvement with liver, bone marrow, or nodular lung
Lymphoid Prognostic Factors

IPI Score
Ann Arbor Stage III or IV = 1
LDH > max normal = 1
Age ≥ 60 = 1
Extranodal disease > 1 site = 1
PFS ECOG ≥ 2 = 1

0-1 point: Low
2 points: Low intermediate
3 points: High intermediate
4-5 points: High
Malignant Melanoma of Uvea:
Choroid and Ciliary Body
T Staging
T1a ≤ 10 mm d and ≤ 2.5 mm ht without micro extraoc ext
T1b ≤ 10 mm d and ≤ 2.5 mm ht with micro extraoc ext
T1c ≤ 10 mm d and ≤ 2.5 mm ht with macro extraoc ext
T2a 10-16 mm d, ht 2.5-10 mm without micro extraoc ext
T2b 10-16 mm d, ht 2.5-10 mm with micro extraoc ext
T2c 10-16 mm d, ht 2.5-10 mm with macro extraoc ext
T3 > 16 mm d or > 10 mm ht wihtout extraoc ext
T4 > 16 mm d or > 10 mm ht with extraoc ext
Malignant Melanoma of Uvea:
Choroid and Ciliary Body
Stage Grouping
I: T1N0M0
II: T2N00
III: T3N0M0, T4N0M0
IV: TxN1M0, TxNxM1
Lymphoid Staging
1 Site
2 Laterality
3 histopathologic type
4 Ann Arbor stage
1 Site: Nodal or extranodal
2 Laterality: Right, Left, Bilateral
3 Histo type: Working Formulation, REAL Classification, T-Cell/NK Neoplasms
4 Ann Arbor stage
Lymphoid Staging: Ann Arbor
I: Single nodal region
IE: Localized single extralymphatic organ without lymph node involvement
II: ≥ 2 lymph node regions on same side of diaphragm
IIE: Single exralymphatic organ with regional node involvement +/- other nodes on same side of diaphragm
III: Nodes on both sides of diaphragm
IIIE: Nodes on both sides +/- extralymphatic extension with adj nodes
IIIS: With spleen
IIIE,S: With extranodal and spleen
IV: Diffuse involvement with liver, bone marrow, or nodular lung
Lymphoid Prognostic Factors

IPI Score
Ann Arbor Stage III or IV = 1
LDH > max normal = 1
Age ≥ 60 = 1
Extranodal disease > 1 site = 1
PFS ECOG ≥ 2 = 1

0-1 point: Low
2 points: Low intermediate
3 points: High intermediate
4-5 points: High
Malignant Melanoma of Uvea:
Choroid and Ciliary Body
T Staging
T1a ≤ 10 mm d and ≤ 2.5 mm ht without micro extraoc ext
T1b ≤ 10 mm d and ≤ 2.5 mm ht with micro extraoc ext
T1c ≤ 10 mm d and ≤ 2.5 mm ht with macro extraoc ext
T2a 10-16 mm d, ht 2.5-10 mm without micro extraoc ext
T2b 10-16 mm d, ht 2.5-10 mm with micro extraoc ext
T2c 10-16 mm d, ht 2.5-10 mm with macro extraoc ext
T3 > 16 mm d or > 10 mm ht wihtout extraoc ext
T4 > 16 mm d or > 10 mm ht with extraoc ext
Malignant Melanoma of Uvea:
Choroid and Ciliary Body
Stage Grouping
I: T1N0M0
II: T2N00
III: T3N0M0, T4N0M0
IV: TxN1M0, TxNxM1
Define vulvar N3/FIGO IVA
Fixed or ulcerated regional LN mets
Define vulvar FIGO stage IIIB
T1-2 N2a-N2b M0
Define vulvar FIGO stage IIIC
T1-2 N2c M0
Define vulvar FIGO stage IVA
T1-2 N3 M0
T3 Any N M0
Define vulvar FIGO stage IVB
Any T Any N M1