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Some common concerns about staging are the following:
- The stage of a cancer is sometimes confused with the grade
of a tumor by new registrars. Terms such as well differentiated
and undifferentiated are tumor grades.
- The rules for each staging scheme must be reviewed for
each site and histology. The AJCC staging systems and summary
staging systems list the sites and histologies to which
specific staging schemes apply.
- The term microinvasion implies invasion through the basement
membrane (an anatomic landmark), indicating that the stage
is invasive instead of in-situ.
- Some cases of cancer are difficult to stage appropriately.
Problem situations include the following:
- Diagnostic tests done on an outpatient basis with
results not documented in the hospital health information
record
- Tests and biopsies done in a physician's office and
sent to freestanding laboratories for assessment
- Conflicting information about the exact location,
size, and involvement of the tumor
There are many resources available for staging cancers. The
registry should have adequate access to appropriate references.
Staging manuals for the most commonly used systems (summary
staging, AJCC staging, and SEER extent of disease) provide
comprehensive guidelines. These should be routinely reviewed
at the time of abstracting to verify the staging classification.
The Commission on Cancer of the American College of Surgeons
requires that staging be done by the managing physician and
recorded in the patient's health information record. This
requirement does not negate the need for the registrar to
understand staging. Verification is necessary at the registry
level to ensure the accuracy and completeness of data. It
is imperative that staging be correct, when registry data
are reported and analyzed.
The patient's treatment is based on the extent of the disease.
The prognosis of the disease can be estimated by the stage
and other factors such as age, aggressiveness of tumor, and
the presence or absence of other medical conditions. In certain
stages of disease, quality of life issues may influence treatment
decisions. The stage of disease is used in research studies
and in the analysis of cancers.
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