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Cancer staging guidance sheets

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Cancer staging guidance sheets


Introduction

What is stage?

The stage of a cancer is a description of how far the cancer has spread. The Union for International Cancer Control (UICC) TNM stage is the most widely used system for staging cancers although there are several other classification systems in use depending on the type of cancer.

Why is staging data important?

Early stage at diagnosis is one of the most important factors affecting cancer outcomes and promoting earlier stage at diagnosis is one of the key aims of the NHS Long Term Plan. Measuring and monitoring national staging data is crucial to understand variation and deliver evidence-based decisions.

What is required for stage?

For TNM there are two staging criteria:

  • FINAL PRETREATMENT - report this stage prior to any treatment
  • INTEGRATED -  where the 1st definitive treatment is surgical resection, then you would report the integrated stage

In addition to the TNM staging classification, there are SITE SPECIFIC STAGING classifications which will also be accepted as a full stage.

Full TNM stage

Cases with valid T, N, and M staging components and a confirmed TNM version number will be accepted as having a full stage.

T, N and M components must not include invalid values such as N/A, Null, O (letter) and ?. Invalid TNM combinations will also be excluded e.g. TX NX MX or T0 N0 M0. Cases with no separate TNM components but a stage group will be accepted as a full stage. All three components (T CATEGORY, N CATEGORY and M CATEGORY) must be complete in either FINAL PRETREATMENT or INTEGRATED to be considered a complete stage. However cases with a known primary site (excluding ICD10 C76-C80) and M1 component do not need a valid T or N component to be accepted as a full stage, as it is considered to be stage 4.

Partial TNM stage

If a case is only provided with one or two of the TNM components, it will be classified as having a partial stage (with the exception of cases provided as M1 as described above). Examples include: T1 NX MX and T2 N1 MX

Site specific stage

Full stage will have been achieved if any of the following staging systems have been completed in a valid way:

Staging system 

Cancer site

Ann Arbor stage

Lymphoma

BINET stage

Chronic Lymphoblastic Leukaemia (CLL)

Chang system

Medullosblastoma

FIGO staging systems

Gynaecology

International Neuroblastoma Risk Group

Neuroblastoma

Murphy St Jude's Staging System

Children Teenage Young Adult (CTYA) Non-Hodgkins Lymphoma (NHL)

Revised International Staging System (R-ISS)

Myeloma

Royal Marsden staging system

Testis

Wilms Tumour stage

Kidney

Note:

Site specific prognostic indicators will NOT be classed as a valid stage:

  • Clarkes
  • Breslow Thickness
  • Gleason Score
  • Fuhrman Grade
  • WHO Grade
  • NPI

CanStaging.org - Free online staging tool

This is free tool created in collaboration with the the UICC,  specifically for clinicians tool to help maximise the availability, standardisation and comparability of cancer staging internationally.

 

Find out more about this free tool on the CanStaging+ website.

How to use the cancer staging guidance sheets

Select from the list below for guidance on how to assign a TNM stage or site-specific stage for each cancer tumour site:

 

 

Last edited: 7 February 2024 9:58 am

  1. Cancer staging guidance sheets
  2. Lip and oral cavity (ICD10 C00, C02-C06)
  3. Malignant melanoma of upper aerodigestive tract (ICD10 C00-06, C10-14, C30-32)
  4. Pharynx (ICD10 C01, C05.1-2, C09, C10.0, C10.2-3, C11-13)
  5. Major salivary glands (ICD10 C07, C08)
  6. Oesophagus including oesophagastric junction (ICD10 C15 & C16.0)
  7. Stomach (ICD10 C16 except C16.0)
  8. Small intestine (ICD10 C17)
  9. Appendix (ICD10 C18.1)
  10. Colon and rectum (ICD10 C18-C20)
  11. Anal canal and perianal skin data (ICD10 C21, C44.5)
  12. Liver (ICD10 C22.0)
  13. Intrahepatic bile ducts (ICD10 C22.1)
  14. Gallbladder (ICD10 C23, C24.0)
  15. Distal extrahepatic bile duct (ICD10 C24.0)
  16. Perihilar bile ducts (ICD10 C24.0)
  17. Ampulla of vater (ICD10 C24.1)
  18. Pancreas (ICD10 C25)
  19. Nasal cavity and paranasal sinuses (ICD10 C30.0, C31.0, C31.1)
  20. Larynx (ICD10 C32.0 C32.1, C32.2, C10.1)
  21. Lung (ICD10 C34)
  22. Thymic tumours (ICD10 C37)
  23. Soft tissues (ICD10 C38.1-2, C47-C49)
  24. Bone (ICD10 C40 & C41)
  25. Malignant melanoma of skin (ICD10 C43, C51.0, C60.9, C63.2)
  26. Merkel cell carcinoma of skin (ICD10 C44 & C63.2)
  27. Skin carcinoma of the head and neck (ICD10 C44.0, C44.2-4)
  28. Carcinoma of skin of the eyelid (ICD10 C44.1)
  29. Carcinoma of skin (excluding eyelid, head and neck, perianal, vulva and penis) (ICD10 C44.5-7, C63.2)
  30. Pleural mesothelioma (ICD10 C45)
  31. Breast tumours (ICD10 C50)
  32. Vulva (ICD10 C51)
  33. Cervix uteri (ICD10 C53)
  34. Uterine sarcomas - (leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma) (ICD10 C53, C54)
  35. Uterus - endometrium (ICD10 C54.1, C55)
  36. Ovarian, fallopian tube and primary peritoneal carcinoma (ICD10 C56, C57, C48.1, C48.2)
  37. Gestational trophoblastic neoplasms (ICD10 C58)
  38. Penis tumours (ICD10 C60)
  39. Prostate tumours (ICD10 C61)
  40. Testis tumours (ICD10 C62)
  41. Kidney tumours (ICD10 C64)
  42. Renal pelvis and ureter tumours (ICD10 C65 & C66)
  43. Urinary bladder tumours (ICD10 C67)
  44. Urethra tumours (ICD10 C68.0)
  45. Carcinoma of conjuctiva (ICD10 C69.0)
  46. Malignant melanoma of conjuctiva (ICD10 C69.0)
  47. Retinoblastoma (ICD10 C69.2)
  48. Malignant melanoma of uvea (ICD10 C69.3, C69.4)
  49. Carcinoma of lacrimal gland (ICD10 C69.5)
  50. Sarcoma of orbit (ICD10 C69.6)
  51. Thyroid gland (ICD10 C73)
  52. Adrenal cortex (ICD10 C74.0)
  53. Chronic lymphocytic leukaemia
  54. Hepatoblastoma (CTYA)
  55. Hodgkins and non-hodgkins lymphoma (ICD10 C81-88)
  56. Medulloblastoma
  57. Multiple myeloma
  58. Neuroblastoma
  59. Neuroendocrine tumours of the foregut - gastric, duodenum, ampulla, proximal jejunum & pancreas
  60. Neuroendocrine tumours of the midgut and hindgut - lower jejunum and ileum, appendix and colon & rectum
  61. Non-hodgkin lymphoma (children)
  62. Rhabdomyosarcoma and other soft tissue sarcomas (CTYA)
  63. Wilms tumour of the kidney