Cancer staging is the process of determining the extent to which a cancer has developed by growing and spreading. Contemporary practice is to assign a number from I to IV to a cancer, with I being an isolated cancer and IV being a cancer which has spread to the limit of what the assessment measures. The stage generally takes into account the size of a tumor, whether it has invaded adjacent organs, how many regional (nearby) lymph nodes it has spread to (if any), and whether it has appeared in more distant locations (metastasized).
The most clinically useful staging system is the tumor, node, and metastasis (TNM) staging system developed by the American Joint Committee on Cancer (AJCC) in collaboration with the Union for International Cancer Control (UICC), herein referred to as the AJCC TNM staging system. The AJCC TNM system classifies cancers by the size and extent of the primary tumor (T), involvement of regional lymph nodes (N), and the presence or absence of distant metastases (M), supplemented in recent years by evidence-based prognostic and predictive factors. There is a TNM staging algorithm for cancers of virtually every anatomic site and histology, with the primary exception of pediatric cancers.
Video Cancer staging
TNM staging system
The AJCC and UICC periodically modify the AJCC TNM staging system in response to newly acquired clinical and pathological data and an improved understanding of cancer biology and other factors affecting prognosis. Periodic and, to the extent possible, evidence-based revision is a key feature that makes this staging system the most clinically useful among staging systems and accounts for its widespread use worldwide. However, because changes in staging systems may make it difficult to compare outcomes of patients over time, evidence-based changes to this staging system are made with deliberate care.
In general, the revision cycle for AJCC TNM staging has historically been 5 to 7 years. This approach provides sufficient time for implementation of changes in clinical management and cancer registry operations and for relevant examination and discussion of data supporting changes in staging. Table 1.1 shows the publication year for each version of the AJCC TNM system up through this current AJCC Cancer Staging Manual, 8th Edition. The AJCC Cancer Staging Manual, 7th Edition was used for cancer patients diagnosed on or after January 1, 2010. The 8th Edition published in this manual is effective for cancer patients diagnosed on or after January 1, 2018. The AJCC recognizes that rapidly evolving evidence may necessitate more frequent updates of AJCC TNM staging in the future, and anticipates providing more frequent updates for disease sites as new and validated evidence becomes available. Moreover, the AJCC also recognizes that as clinical cancer care continues to evolve and incorporates factors that are not used to determine stage but that provide key information on specific outcomes and/or expected benefit from specific therapies, new, validated clinical tools will be needed to help clinicians efficiently and accurately use these important data to enhance clinical care (see Anatomic Staging and the Evolving Use of Nonanatomic Factors).
see AJCC Cancer Staging Manual Publishing History
Cancer staging can be divided into a clinical stage and a pathologic stage. In the TNM (Tumor, Node, Metastasis) system, clinical stage and pathologic stage are denoted by a small "c" or "p" before the stage (e.g., cT3N1M0 or pT2N0). This staging system is used for most forms of cancer, except brain tumors and hematological malignancies.
- Clinical stage is based on all of the available information obtained before a surgery to remove the tumor. Thus, it may include information about the tumor obtained by physical examination, blood tests, radiologic examination, biopsy, and endoscopy.
- Pathologic stage adds additional information gained by examination of the tumor microscopically by a pathologist after it has been surgically removed.
Because they use different criteria, clinical stage and pathologic stage often differ. Pathologic staging is usually considered to be more accurate because it allows direct examination of the tumor in its entirety, contrasted with clinical staging which is limited by the fact that the information is obtained by making indirect observations of a tumor which is still in the body. However, clinical staging and pathologic staging often complement each other. Not every tumor is treated surgically, therefore pathologic staging is not always available. Also, sometimes surgery is preceded by other treatments such as chemotherapy and radiation therapy which shrink the tumor, so the pathologic stage may underestimate the true stage.
Maps Cancer staging
Considerations
Correct staging is critical because treatment (particularly the need for pre-operative therapy and/or for adjuvant treatment, the extent of surgery) is generally based on this parameter. Thus, incorrect staging would lead to improper treatment.
For some common cancers the staging process is well-defined. For example, in the cases of breast cancer and prostate cancer, doctors routinely can identify that the cancer is early and that it has low risk of metastasis. In such cases, medical specialty professional organizations recommend against the use of PET scans, CT scans, or bone scans because research shows that the risk of getting such procedures outweighs the possible benefits. Some of the problems associated with overtesting include patients receiving invasive procedures, overutilizing medical services, getting unnecessary radiation exposure, and experiencing misdiagnosis.
The AJCC TNM stage for each cancer type is built by defining the anatomic extent of cancer for the tumor (T), lymph nodes (N), and distant metastases (M), supplemented in some cases with nonanatomic factors. For each of the T, N, and M, there is a set of categories, most often defined by a number (e.g., T1, N2). The description of the anatomic factors is specific for each disease site. These descriptors and the nomenclature for TNM have been developed and refined over many editions of the AJCC Cancer Staging Manual by experts in each disease and by cancer registrars who collect the information, taking into consideration the behavior and natural history of each type of cancer. These elements are then combined, in a fashion set forth for each cancer type, into prognostic stage groups (often called "stage groups").
Importantly, the term stage should be used only to describe the aggregate information resulting from T, N, and M category designations (i.e., based on T, N, and M classifications) combined with any prognostic factors relevant to the specific disease. The term stage should not be used to describe individual T, N, or M category designations that often are mistakenly referred to as "stage."
Assigning the T, N, and M categories follows general rules described in the tables in this chapter. These rules apply to all cancer sites, with relatively few exceptions. These exceptions are defined in the relevant disease-specific chapters.
Rules are repeated throughout this chapter to facilitate easy reference based on the topic.
Before delineating the specific rules for T, N, and M categorization and for generating prognostic stage groups, it is important to first delineate the time points, termed classifications, at which staging information is collected and reported.
TNM Staging Classification: Clinical, Pathological, Posttherapy, Recurrence, and Autopsy
Stage may be defined at several time points in the care of the cancer patient. To properly stage a patient's cancer, it is essential to first determine the time point in a patient's care. These points in time are termed classifications, and are based on time during the continuum of evaluation and management of the disease. Then, T, N, and M categories are assigned for a particular classification (clinical, pathological, posttherapy, recurrence, and/or autopsy) by using information obtained during the relevant time frame, sometimes also referred to as a staging window. These staging windows are unique to each particular classification and are set forth explicitly in the following tables. The prognostic stage groups then are assigned using the T, N, and M categories, and sometimes also site-specific prognostic and predictive factors.
Among these classifications, the two predominant are clinical classification (i.e., pretreatment) and pathological classification (i.e., after surgical treatment).
Clinical Classification (cTNM)
Clinical stage classification is based on patient history, physical examination, and any imaging done before initiation of treatment. Imaging study information may be used for clinical staging, but clinical stage may be assigned based on whatever information is available. No specific imaging is required to assign a clinical stage for any cancer site. When performed within this framework, biopsy information on regional lymph nodes and/or other sites of metastatic disease may be included in the clinical classification.
Clinical evaluation by physical examination often underestimates the extent of cancer burden at the time of patient presentation. Although imaging is not required to assign clinical stage, clinical imaging has become increasingly important, and for many cancer sites, imaging is essential to stage solid tumors accurately. Imaging allows assessment of the tumor's size, location, and relationship to normal anatomic structures, as well as the existence of nodal and/or distant metastatic disease. Computed tomography (CT) and magnetic resonance (MR) imaging are the most commonly used imaging modalities, although positron emission tomography (PET; often combined with CT), ultrasound, and plain film radiography also have important roles in various clinical situations. Thus, a new section was added to the disease site chapters to provide context-specific imaging information. To adequately and comprehensively communicate essential information, radiologists should use standardized nomenclature and structured report formats, such as those recommended by the Radiological Society of North America (RSNA) reporting initiative (http://www.rsna.org/Reporting_Initiative.aspx). In addition to providing key information for assigning the T, N, and M categories, clinical imaging is invaluable for guiding biopsies and surgical resections. Later in the course of a patient's treatment, imaging also often plays an important role in monitoring response to treatment.
Pathological Classification (pTNM)
Pathological stage classification is based on clinical stage information supplemented/modified by operative findings and pathological evaluation of the resected specimens. This classification is applicable when surgery is performed before initiation of adjuvant radiation or systemic therapy.
Posttherapy or Post Neoadjuvant Therapy (ycTNM and ypTNM)
Stage determined after treatment for patients receiving systemic and/or radiation therapy alone or as a component of their initial treatment, or as neoadjuvant therapy before planned surgery, is referred to as posttherapy classification. It also may be referred to as post neoadjuvant therapy classification.
Recurrence or Retreatment (rTNM)
Staging classifications at the time of retreatment for a recurrence or disease progression is referred to as recurrence classification. It also may be referred to as retreatment classification.
Autopsy (aTNM)
Staging classification for cancers identified only at autopsy is referred to as autopsy classification.
Pathologic
Pathologic staging, where a pathologist examines sections of tissue, can be particularly problematic for two specific reasons: visual discretion and random sampling of tissue. "Visual discretion" means being able to identify single cancerous cells intermixed with healthy cells on a slide. Oversight of one cell can mean mistaging and lead to serious, unexpected spread of cancer. "Random sampling" refers to the fact that lymph nodes are cherry-picked from patients and random samples are examined. If cancerous cells present in the lymph node happen not to be present in the slices of tissue viewed, incorrect staging and improper treatment can result.
Current research
New, highly sensitive methods of staging are in development. For example, the mRNA for GCC (guanylyl cyclase c), present only in the luminal aspect of intestinal epithelium, can be identified using molecular screening (RT-PCR) with a high degree of sensitivity and exactitude. Presence of GCC in any other tissue of the body represents colorectal metaplasia. Because of its high sensitivity, RT-PCR screening for GCC greatly reduces underestimation of disease stage. Researchers hope that staging with this level of precision will lead to more appropriate treatment and better prognosis. Furthermore, researchers hope that this same technique can be applied to other tissue-specific proteins.
AJCC Prognostic Stage Groups
For the purposes of tabulation and to analyze the care of patients who generally have a similar prognosis, T, N, and M are grouped into prognostic stage groups, commonly referred to as stage groups. As introduced earlier, a stage group is determined from aggregate information on the primary tumor (T), regional lymph nodes (N), and distant metastases (M), as well as any specified prognostic factors for certain cancer types. Stage groups are based primarily on anatomic information, supplemented by selected prognostic factors in some disease sites. Stage groups are defined for each of the classifications: clinical stage group and pathological stage group.
Systems
Staging systems are specific for each type of cancer (e.g., breast cancer and lung cancer). Some cancers, however, do not have a staging system. Although competing staging systems still exist for some types of cancer, the universally-accepted staging system is that of the UICC, which has the same definitions of individual categories as the AJCC.
Systems of staging may differ between diseases or specific manifestations of a disease.
Blood
- Lymphoma: uses Ann Arbor staging
- Hodgkin's Disease: follows a scale from I to IV and can be indicated further by an A or B, depending on whether a patient is non-symptomatic or has symptoms such as fevers. It is known as the "Cotswold System" or "Modified Ann Arbor Staging System".
Solid
For solid tumors, TNM is by far the most commonly used system, but it has been adapted for some conditions.
- Breast cancer: In breast cancer classification, staging is usually based on TNM, but staging in I-IV may be used as well.
- Cervical and ovarian cancers: the "FIGO" system has been adopted into the TNM system. For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading system is used.
- Colon cancer: originally consisted of four stages: A, B, C, and D (the Dukes staging system). More recently, colon cancer staging is indicated either by the original A-D stages or by TNM.
- Kidney cancer: uses TNM.
- Cancer of the larynx: Uses TNM.
- Liver cancer: Uses TNM.
- Lung cancer: uses TNM.
- Melanoma: TNM used. Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion ("Microstaging").
- Prostate cancer: TNM almost universally used.
- Testicular cancer: uses TNM along with a measure of blood serum markers (TNMS).
- Non-melanoma skin cancer: uses TNM.
- Bladder cancer: uses TNM.
Overall stage grouping
TNM information in each chapter provides precise criteria and rules for categorizing the T, N, or M of a patient for the relevant classification (e.g., clinical, pathological). This information is used to assign prognostic stage groups based on the assigned T, N, and M categories (with other prognostic factors if required for that specific cancer type).
T, N, M and Prognostic Factor Category Criteria
The three categories--T, N, and M--and the prognostic factors collectively describe, with rare exceptions, the extent of tumor, including local spread, regional nodal involvement, and distant metastasis. It is important to stress that each component (T, N, and M) is referred to as a category. The term stage is used when T, N, and M and cancer site-specific required prognostic factors are combined. The criteria for T, N, and M are defined separately for cancers in different anatomic locations and/or for different histologic types.
Primary Tumor (T) Categories
Primary tumor categories have specific notations to describe the existence, size, or extent of the tumor.
Regional Lymph Node (N) Categories
Categorizing regional lymph node involvement depends on its existence and extent.
Distant Metastasis (M) Categories
The distant metastasis category specifies whether distant metastasis is present.
Notes:
There is no designation of MX. The absence of any clinical history or physical findings suggestive of metastases in a patient who has not undergone any imaging is sufficient to assign the clinical M0 category (cM0).
There is no designation of pM0. Biopsy or other pathological information is required to assign the pathological M1 category. Patients with a negative biopsy of a suspected metastatic site are classified as clinical M0 (cM0).
Distant Metastasis: Selected Locations
The M1 category may be specified further according to the location of distant metastases.
Unknown Designation: X
The X designation is used if information on a specific T or N category is unknown; such cases usually cannot be assigned a stage. Therefore, TX and NX should be used only if absolutely necessary. Of note, there is no MX category.
Exceptions: TX
Stage may be assigned when the TNM stage group results in Any T or Any N with M1, which includes TX or NX. These are classified as Stage IV. Examples include:
- TX NX M1, or
- TX N3 M1.
Stage may be assigned when the TNM stage group results in Any T or Any N with M0, which includes TX or NX. Examples include:
- TX N1 M0 Stage III in melanoma clinical stage
- T4 NX M0 Stage III in pancreas
MX is Not a Valid M Category
The MX category was eliminated from the AJCC and UICC TNM systems in the AJCC Cancer Staging Manual, 6th Edition. Unless there is clinical or pathological evidence of distant metastases, the patient is classified as clinical M0 and denoted as cM0. It is not necessary to perform any imaging or invasive studies to categorize a patient as cM0. A history and physical examination are all that is needed to assign cM0. The M category must always be known and reported to assign a stage group.
Pathologists should not report an M category unless appropriate for the specimen evaluated. CAP Cancer Protocols require documentation of distant metastases as pM1 only if present in the specimen(s) provided to the pathologist. If the pathologist does not review and report on a metastatic specimen, or if a biopsy is performed of a possible distant metastasis and the biopsy does not show cancer, then there should be no mention of the M category in the pathology report, or the pathologist should designate the M category as "not applicable." The term MX should not be used in the pathology report.
The managing physician should stage a patient for whom a biopsy performed for possible distant metastasis does not demonstrate cancer as cM0; there is no pM0 designation. Only the managing physician can assign cM0 after taking into account physical examination, imaging, and other information.
AJCC Prognostic Stage Groups
The purpose of defining and assigning stage groups is to generate a reproducible and easily communicated summary of staging information. The staging tables generally group patients with similar prognoses, usually with a statistically significant separation in outcomes between stage groups. Patients within a stage group generally have similar outcomes, even though their burden of disease may vary. Exceptions to this general stage group convention are noted in each chapter where relevant. For example, to retain an anatomic- and TNM-based staging system in melanoma, some prognostic overlap was allowed between patients with Stage IIC melanoma and those with Stage IIIA melanoma; many patients with Stage IIIA disease have a prognosis more favorable than that of patients with Stage IIC disease.
Stage groups are denoted by Roman numerals from I to IV with increasing extent of disease and generally with worsening overall prognosis. Stage I generally indicates cancers that are smaller or less deeply invasive without regional disease or nodes, Stages II and III define patients with increasing tumor or nodal extent, and Stage IV identifies those who present with distant metastases (M1) at diagnosis.
The term Stage 0 is used to denote carcinoma in situ (or melanoma in situ for melanoma of the skin or germ cell neoplasia in situ for testicular germ cell tumors) and generally is considered to have no metastatic potential. Stage 0 is determined by microscopic examination of the primary tumor. Stage I through Stage IV subgroups are denoted by capital letters--for example, A, B, or C--according to cancer site stage grouping definitions and are used to expand the main groupings to provide more refined prognostic information.
Prognostic Factors Required for Stage Grouping
For some cancer types, in addition to T, N, and M categories, prognostic factors are required to assign a stage group. Examples include tumor grade, age at diagnosis, histologic type, mitotic rate, serum tumor markers, hormone receptors, hereditary factors, prostate-specific antigen, and Gleason score. Specifically, cancer site-specific prognostic factors populate nonanatomic categories and are defined clearly if required for a particular disease site.
These factors generally constitute categories used with the TNM categories to assign prognostic stage groups. In some cases in which factors are used in stage groups, an X category is provided for use by the managing physician if the factor is not available. Generally, in cases in which the factor is absent and X is not provided as an option, the physician's determination or lowest category (best prognosis) of the factor is used to assign the stage group.
In contrast, cancer registry data collection should record X or unknown if the prognostic factor is not available, and should not use the lowest category. This allows for accurate analysis of the data.
Stage Classifications
Stage classifications are determined according to the point in time of the patient's care in relation to diagnosis and treatment. The five stage classifications are clinical, pathological, posttherapy/post neoadjuvant therapy, recurrence/retreatment, and autopsy.
Clinical Classification
Classification of T, N, and M during the diagnostic workup time frame is denoted by use of a lower case c prefix: cT, cN, and cM0, cM1 or pM1, or the use of no prefix: T, N, M.
Clinical stage is important to record for all patients because:
- clinical stage is essential for selecting initial therapy, and
- clinical stage is critical for comparison across patient cohorts when some have surgery as a component of initial treatment and others do not.
Clinical stage may be the only stage classification by which comparisons can be made across all patients, because not all patients will undergo surgical treatment before other therapy, and response to treatment varies. Differences in primary therapy make comparing groups of patients difficult if that comparison is based on pathological assessment. For example, it is difficult to compare patients treated with primary surgery with those treated with chemotherapy or radiotherapy without surgery or neoadjuvant therapy.
Time frame: Clinical classification is based on any information gathered about the extent of the cancer from the time of diagnosis until the initiation of primary treatment or the decision for watchful waiting or supportive care, and is based on the shorter of two periods of time:
- within 4 months after diagnosis, or
- the time of cancer progression if the cancer progresses before the end of the 4-month window; data on the extent of the cancer is included only before the date of observed progression
Criteria: All patients with cancer identified before treatment.
Clinical classification is based on:
- clinical history and symptoms
- physical examination
- imaging
- endoscopy or surgical exploration without resection
- biopsy of the primary site, biopsy or excision of a single regional node or sentinel nodes, sampling of regional nodes with clinical T, or biopsy of a distant metastatic site
Clinical classification is based on evidence acquired from the date of diagnosis until initiation of primary treatment. Examples of primary treatment include definitive surgery, radiation therapy, systemic therapy, and neoadjuvant radiation and systemic therapy.
Importantly, clinical stage groups cannot be assigned for some cancer sites if the necessary minimum information to assign a clinical stage group is not available. Although this scenario is quite uncommon, it may occur--for example, if lymph nodes cannot be examined before surgical resection or if a cancer is identified and resected incidentally during surgery for another medical condition.
Clinical T (T or cT)
Assessment of the primary tumor is necessary to determine the cT category.
Clinical N (N or cN)
Assessment of the regional lymph nodes is necessary to determine the cN category.
Clinical M Classification (cM and pM)
Assignment of the M category for clinical classification may be cM0, cM1, or pM1. The M category is based on clinical history, physical examination, any imaging results, and whether there is microscopic confirmation of the distant metastasis during the diagnostic workup. The terms pM0 and MX are NOT valid categories in the TNM system.
Pathological Classification
Classification of T, N, and M after surgical treatment is denoted by use of a lowercase p prefix: pT, pN, and cM0, cM1, or pM1.
Time frame: From date of diagnosis through surgical resection in the absence of cancer progression
Criteria: Surgery is first therapy
Pathological classification is based on the:
- clinical stage information (acquired before treatment), and supplemented/modified by
- operative findings, and
- pathological evaluation of the resected specimen(s).
Pathological stage is assigned for patients first treated with surgery. The surgical resection required for assignment of this classification is specified for each disease site, and ranges from resection of the tumor to complete resection of the organ and usually includes resection of at least some of the regional lymph nodes.
The purpose of pathological classification is to provide additional precise and objective data:
- for prognosis and outcomes, and
- to guide subsequent therapy.
Pathological T (pT)
The pathological assessment of the primary tumor generally is based on resection of the primary tumor.
Pathological N (pN)
Pathological assessment of regional node involvement (pN) is necessary.
Pathological M Categorization (cM and pM)
Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping. The terms pM0 and MX are NOT valid categories in the TNM system.
Posttherapy or Post Neoadjuvant Therapy Classification (yTNM)
For purposes of posttherapy or post neoadjuvant therapy classification, neoadjuvant therapy is defined as systemic and/or radiation therapy given before surgery; primary radiation and/or systemic therapy is treatment given as definitive therapy without surgery.
Classification of T, N, and M after systemic or radiation treatment intended as definitive therapy, or after neoadjuvant therapy followed by surgery, is denoted by use of a lowercase yc or yp prefix, respectively: ycT, ycN, c/pM, and ypT, ypN, c/pM, respectively. The c/pM category may include cM0, cM1, or pM1.
yc
Time frame: After primary systemic and/or radiation therapy without subsequent surgical resection, or after neoadjuvant and before planned surgical resection
Criteria: First therapy is systemic and/or radiation therapy.
y-clinical (yc) classification is based on the:
- clinical history and physical examination and
- any imaging studies, if performed
Note: imaging studies may be considered standard practice, but are NOT required to assign yc categories.
yp
Time frame: The yp classification is used when staging after neoadjuvant therapy and planned post neoadjuvant therapy surgery. The time frame should be such that the post neoadjuvant therapy surgery and staging occur within a period that accommodates disease-specific circumstances, as outlined in the specific chapters and in relevant guidelines.
Criteria: First therapy is systemic and/or radiation therapy followed by surgery.
y-pathological (yp) classification is based on the:
- y-clinical stage information, and supplemented/modified by
- operative findings, and
- pathological evaluation of the resected specimen.
Observed changes between the clinical classification and the posttherapy classification may provide clinicians with information regarding the response to therapy. The clinical extent of response to therapy may guide the scope of planned surgery, and the clinical and pathological extent of response to therapy may provide prognostic information and guide the use of further adjuvant radiation and/or systemic therapy.
Examples of treatments that satisfy the definition of neoadjuvant therapy for a disease site may be found in sources such as the NCCN Guidelines, ASCO guidelines, or other treatment guidelines. Systemic therapy includes chemotherapy, hormone therapy, and immunotherapy. Not all medication given to a patient meets the criteria for neoadjuvant therapy (e.g., a short course, such as a few days of endocrine therapy in breast cancer or prostate cancer that is provided for variable and often unconventional reasons, should not be categorized as neoadjuvant therapy).
The time frame should be such that the post neoadjuvant therapy surgery and staging occur within a period that accommodates disease-specific circumstances, as outlined in the specific chapters and in relevant guidelines.
The post neoadjuvant therapy assessment of the T and N (yTNM) categories uses specific criteria. In contrast, the M category for post neoadjuvant therapy classification remains the same as that assigned in the clinical stage before initiation of neoadjuvant therapy (e.g., if there is a complete clinical response to therapy in a patient previously categorized as cM1, the M1 category is used for final yc and pc staging).
[null Recurrence or Retreatment Classification (rTNM])
Classification of T, N, and M for recurrence or retreatment is denoted by use of the lowercase r prefix: rcT, rcN, rc/rpM, and rpT, rpN, rc/rpM. The rc/rpM may include rcM0, rcM1, or rpM1.
Time frame: From identification of recurrence or progression until treatment is initiated
Criteria: Disease recurrence after disease-free interval, or disease progression
The recurrence or retreatment classification is assigned if a cancer recurs after an interval during which the patient has been considered cancer-free (disease-free interval), or if the cancer progresses and the patient has never been disease-free (even if no retreatment is planned).
Assessment of recurrence and retreatment follows specific criteria.
Autopsy Classification (aTNM)
Classification of T, N, and M at autopsy is denoted by use of the lowercase a prefix: aT, aN, aM.
Time frame: At death
Criteria: Incidental finding of cancer at autopsy; cancer not suspected or evident before death (i.e., classification does not apply if autopsy is performed in a patent with a known cancer before death).
Autopsy assessment has specific criteria.
AJCC Educational Resources
AJCC provides staging resources for the physician to support their care of patients. The AJCC provides webinars, presentations, articles, brochures and other resources all of which can be obtained on the AJCC website.
Registrar
AJCC is dedicated to supporting cancer registrars in the transition to directly assigning AJCC TNM stage.
Please visit the AJCC website for all registrar focused education.
Physician
The AJCC provides resources beneficial to physicians in their use and understanding of the AJCC TNM staging system.
Articles
Articles on the AJCC staging system from various medical journals are available for physicians to better understand the issues.
7th Edition | 8th Edition
Webinars
Webinars on the AJCC staging rules and the most common disease sites have been recorded by the physician expert panels members involved in that disease site.
7th Edition | 8th Edition
AJCC Cancer Staging Manual Publishing History
The publication dates and effective dates for past editions of the AJCC Cancer Staging Manual are:
References
External links
- "Staging: Questions and Answers" at the National Cancer Institute
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