1. Staging System and Excision Types Tae Won Kim, MD PCOM Tumor Review 4.23.16

2. Cancer Staging 1.What is cancer staging? 2.Why do we do it? 3.What is the most commonly utilized staging system? 4.What factors are taken into account? 5.What are the staging system used in bone and soft tissue sarcomas?

3. What is cancer staging? “Cancer staging is the process of determining how much cancer is in the body and where it is located. Staging describes the severity of an individual's cancer based on the magnitude of the original (primary) tumor as well as on the extent cancer has spread in the body” -American Joint Committee on Cancer

4. Why do we do it? 1.Helps develop prognosis for patients 2.Creates a standard communication tool for doctors

5. What is the most commonly used staging system? AJCC (American Joint Committee on Cancer)

6. What factors are taken into account? T – Primary tumor size/extent N – Nodal involvement M – Metastatic lesions

7. Example: Breast Individualized AJCC for each type of cancer T, N, M defined differently for each cancer type

8. What are the staging system used in bone and soft tissue sarcomas?

9. Bone Sarcomas

10. Soft Tissue Sarcoma

11. Types of Margins

12. A 13-year-old girl presents with an isolated distal femur osteosarcoma that extends into the soft tissue. Work-up is negative for metastasis, but biopsy reveals a high grade lesion. What is the stage of this tumor by the Musculoskeletal Tumor Society system? 1. I A 2. II A 3. I B 4. II B 5. III This patient has a osteosarcoma that is high grade, extracompartment, and without metastases, so it is a IIB by the MSTS Staging System. This is the most common MSTS stage for an osteosarcoma to present. Here is a review of the stages in the MSTS (Enneking) Staging System: (I-A = Low Grade, intracompartmental, No Metastases); (I-B = Low Grade, extracompartment, No Metastases); (II-A = High Grade, intracompartmental, No Metastases); (II-B = High Grade, extracompartment, No Metastases); (III = Any Grade, Distant Metastases).