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