Cancer staging classifies how far a cancer has spread and is an important factor in determining treatment. The TNM system stages most cancers based on tumor size (T), lymph node involvement (N), and metastasis (M). A pathological stage is assigned after surgery. Staging helps doctors determine prognosis and the most appropriate treatment for a patient's individual cancer.

1. Staging in Cancer

2. What is cancer staging?
• An important part of treating a patient’s
cancer is to first find out how far it has spread
- or what “stage” it has reached
• Staging is a system that is used to classify the
extent of cancer
• This information is vital to decide what
treatment is appropriate

3. When do you stage cancer?
• Usually, the cancer is staged at the time of
diagnosis
• This may not be possible if patient present as an
emergency
• After surgery, a pathologist studies tissue the
surgeon removed and assigns it a “pathological
stage”
• In general, the pathological stage is the most
important one in making treatment decisions

4. What is the TNM system?
• Standard system for staging most cancer
• Based on the tumour, lymph node, and
metastasis (TNM)
• The American Joint Committee on Cancer
(AJCC) developed the TNM system and
maintains and updates it
• The TNM system serves as a “common
language” in cancer care

5. What is the TNM system?
• The “T” in TNM relates to tumour. It indicates
tumour size, extent, or penetration (depth) of the
tumour.
• The “N” stands for node. It indicates the number
of lymph nodes with cancer or the location of the
cancer-involved lymph nodes.
• The “M” stands for distant metastasis, or spread
of the cancer to other parts of the body.

6. What is the TNM system?
• Different tumours may spread to different parts
of the body. It is important to test whether the
tumour has spread to other organs
• Patients can have tests such as computed
tomography (CT scans), magnetic resonance
imaging (MRI), positron emission tomography
(PET scans) and/or laparoscopy to stage cancer
• After staging of the cancer, the patient and the
doctor can then make a treatment plan

7. Common cancers using TNM staging
• The most common cancers that doctors stage
using the TNM system are breast, colorectal,
stomach, oesophagus, pancreas, and lung
• Other cancers staged with the TNM system
include soft tissue sarcoma and melanoma
• Staging systems exist for 52 sites or types of
cancer

8. Cancer using other staging system
• Some cancers are not staged using the TNM
system. Cancers of the blood, bone marrow,
brain, and other sites do not use the TNM staging
• Gynaecological cancers use another staging
system (FIGO)
– The International Federation of Gynaecology and
Obstetrics, usually just FIGO as the acronym of its
French name Fédération Internationale de
Gynécologie et d'Obstétrique

9. Other Pathological Staging
• Dukes staging of colorectal cancer
• Based on histological examination of the
resected colorectal cancer specimen

10. • A - Invasive carcinoma not
breaching the muscularis
propria
• B - Invasive carcinoma
breaching the muscularis
propria, but not involving
regional lymph nodes
• C - Invasive cancer
involving the regional
lymph nodes
Dukes’ Staging

11. What does stage grouping mean?
• Once the TNM categories have been determined,
they can place the cancer into a “stage group”
• Stage grouping uses Roman numeral I, II, III, or IV
• The larger the stage number, the more advanced
the stage of cancer
• Staging information is useful to:
– guide adjuvant treatment such as chemotherapy /
radiotherapy
– determine prognosis and survival