AJCC Staging
Staging is used to determine the extent of disease in an individual. The American Joint Committee on Cancer's (AJCC) system for the staging of cancer, preferred for the staging of solid tumors, is based on the evaluation of the T, N and M components and the assignment of a stage grouping. The T element designates the size and/or invasiveness of the primary tumor. The N component designates the presence or absence of tumor in the regional lymph nodes. The M component identifies the presence or absence of distant metastases, including the spread to lymph nodes that are beyond regional lymph node drainage. The system is specific for all of the different anatomic sites with respect to T and N.
TNM results can then be incorporated into larger groupings called stages. Most tumors proceed from Stage I through Stage IV. Prognosis worsens with stage progression for any given disease. Stave IV disease is generally metastatic, whereas Stage I disease is confined to the organ of origin.
Purpose of Staging Cancer
Cancer treatment decisions are influenced, in part, according to the stage of disease, since it is important for the physician to adequately assess the extent of cancer in order to treat the disease in the most appropriate manner. Based on a detailed knowledge of the extent of the disease, cancer specialists can make recommendations about the chances to give the patient the best possible outcome, or additional treatments.
Staging is also used to indicate prognosis or survival. Data from historical sources can provide an estimate of the expected survival rate for a particular cancer with a corresponding extent of disease. In addition to stage; histology, grade of tumor, age, sex, race and the effectiveness of therapy contribute to determining the patient's prognosis and survival.
As an important component of cancer statistics, staging also plays an important role in the evaluation of programs and as a mechanism for comparing the results of different therapeutic procedures and data generated by different institutions.
Staging at Dominican Hospital
Since staging is an important device in the treatment of cancer, the Cancer Committee has looked at the quality of its staging procedures. During the past year, the Committee has tracked the usage and accuracy of staging for analytic cancer patients receiving care at Dominican Hospital. We found that while the accuracy was above the required level, the staging was still somewhat underutilized.
The Committee turned its attention to the process by which staging is encouraged and documented by physicians. We then modified the process according to changing requirements by the ACoS by adding to existing staging requirements so that each case that is presented at Cancer Conference is clinically staged at he time of the treatment planning discussion. The result was an increase in compliance in the usage of staging.
The Cancer Committee was pleased with its improvement in compliance with the American College of Surgeons Commission on Cancer requirements on staging.
