Stage Information
Grade and TNM Definitions
AJCC Stage Groupings
Staging has an important role in determining the most effective treatment of
soft tissue sarcomas. The stage is determined by the size of the tumor, the
histologic grade, and whether it has spread to lymph nodes or distant sites.
Intracompartmental or extracompartmental extension of extremity sarcomas is
also important for surgical decision making. For complete staging, a thorough
physical examination, x-rays, laboratory studies, and careful review of all
biopsy specimens (including those from the primary tumor, lymph nodes, or other
suspicious lesions) are essential. Computed tomographic scan of the chest is
recommended for sarcomas larger than 5 cm (T2) or with moderate to
poor differentiation (grades 2–4). Nodal involvement is rare, occurring in
less than 3% of patients with sarcoma.[1]
The American Joint Committee on Cancer (AJCC) has designated staging by the
four criteria of tumor size, nodal status, grade, and metastasis (TNGM).[2]
Grade and TNM Definitions
Tumor grade (G)
- GX: Grade cannot be assessed
- G1: Well differentiated
- G2: Moderately differentiated
- G3: Poorly differentiated
- G4: Poorly differentiated or undifferentiated
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- T1: Tumor 5 cm or less in greatest dimension
- T1a: Superficial tumor
- T1b: Deep tumor
- T2: Tumor 5 cm or larger in greatest dimension
- T2a: Superficial tumor
- T2b: Deep tumor
[Note: Superficial tumor is located exclusively above the superficial fascia
without invasion of the fascia; deep tumor is located either exclusively
beneath the superficial fascia, or superficial to the fascia with invasion of
or through the fascia, or both superficial yet beneath the fascia. Retroperitoneal,
mediastinal, and pelvic sarcomas are classified as deep tumors.]
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Regional lymph node metastasis [Note: Presence of positive nodes (N1) is considered stage IV.]
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
AJCC Stage Groupings
Stage I
Stage I tumor is defined as low-grade, superficial, and deep.
- G1, T1a, N0, M0
- G1, T1b, N0, M0
- G1, T2a, N0, M0
- G1, T2b, N0, M0
- G2, T1a, N0, M0
- G2, T1b, N0, M0
- G2, T2a, N0, M0
- G2, T2b, N0, M0
Stage II
Stage II tumor is defined as high-grade, superficial, and deep.
- G3, T1a, N0, M0
- G3, T1b, N0, M0
- G3, T2a, N0, M0
- G4, T1a, N0, M0
- G4, T1b, N0, M0
- G4, T2a, N0, M0
Stage III
Stage III tumor is defined as high-grade, large, and deep.
- G3, T2b, N0, M0
- G4, T2b, N0, M0
Stage IV
Stage IV is defined as any metastasis to lymph nodes or distant sites.
- Any G, any T, N1, M0
- Any G, any T, N0, M1
References
-
Fong Y, Coit DG, Woodruff JM, et al.: Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 217 (1): 72-7, 1993.
[PUBMED Abstract]
-
Soft tissue sarcoma. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 193-7.
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