Σταδιοποίηση σε Ca Οστών

Ca Οστών - Πρωτοπαθές

AJCC Stages

Stages

T

N

M

G

IA

T1

N0

M0

G1, G2 (low grade)

IB

T2

N0

M0

G1, G2 (low grade)

T3

N0

M0

G1, G2 (low grade)

IIA

T1

N0

M0

G3, G4 (high grade)

IIB

T2

N0

M0

G3, G4 (high grade)

III

T3

N0

M0

G3, G4 (high grade)

IVA

Any T

N0

M1a

Any G

IVB

Any T

N1

Any M

Any G

Any T

Any N

M1b

Any G

All stage I tumors are low grade and have not spread to regional lymph nodes or to other distant sites. All stage II tumors are high grade and have not spread to another site within the bone or to regional lymph nodes or to other distant sites. Stage III tumors are high grade and have spread to another site within the bone of origin or an immediately adjacent bone but have not spread to regional lymph nodes or to other distant sites. Stage IVA tumors have metastasized to the lung. They may be of any size, any grade, and have not spread to regional lymph nodes. Stage IVB tumors have spread to regional lymph nodes &/or metastasized to sites other than the lung. They may be of any size and grade.

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤ 8 cm in greatest dimension

T2

Tumor > 8 cm in greatest dimension

T3

Discontinuous tumors in primary bone site

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

M1a

Lung

M1b

Other distant sites

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated; note that Ewing sarcoma is considered G4

Stage

Grade (G: Histologic)

Site (T)*

Metastases (M)

Καλοήθη

1: Inactive

G0 (benign)

T0 (intracompartmental)

M0 (no metastases)

2: Active

G0 (benign)

T0 (intracompartmental)

M0 (no metastases)

3: Aggressive

G0 (benign)

T1-2 (extracapsular, intracompartmental OR extracapsular, extracompartmental)

M0-1 (± metastases)

Κακοήθη

Ia: Low grade without metastases, intracompartmental

G1 (low grade, malignant)

T1 (extracapsular, intracompartmental)

M0 (no metastases)

Ib: Low grade without metastases, extracompartmental

G1 (low grade, malignant)

T2 (extracapsular, extracompartmental)

M0 (no metastases)

IIa: High grade without metastases, intracompartmental

G2 (high grade, malignant)

T1 (extracapsular, intracompartmental)

M0 (no metastases)

IIb: High grade without metastases, extracompartmental

G2 (high grade, malignant)

T2 (extracapsular, extracompartmental)

M0 (no metastases)

III: Low or high grade with metastases

G2 (high grade, malignant)

T2 (extracapsular, extracompartmental)

M1 (metastases)

*Site evaluation is performed by cross-sectional imaging. 
T0 = true capsule surrounds lesion (reactive rim of tissue, termed "intracompartmental"); T1 = lesion extends through capsule but remains within compartment (extracapsular, intracompartmental); T2 = lesion extends beyond capsule as well as outside of compartment (extracapsular, extracompartmental). 
Compartments are defined as follows: (a) skin: Subcutaneous, (b) paraosseous: Potential compartment is seen when a lesion pushes muscle away from bone without invading either muscle or cortex, (c) bone: Intracortical (entire bone is the compartment; also a lesion in ray of hand or foot is considered intracompartmental), (d) muscle compartments (posterior compartment calf, anterior compartment calf, anterolateral compartment calf, anterior thigh, medial thigh, posterior thigh, buttocks, volar forearm, dorsal forearm, anterior arm, posterior arm, deltoid, periscapular). Additionally, lesions are considered extracompartmental if they abut major neurovascular structures. Finally, some sites are extracompartmental by origin: Mid-hand (dorsal or palmar), mid-foot, hindfoot, popliteal fossa, femoral triangle, obturator foramen, sciatic notch, antecubital fossa, axilla, periclavicular, paraspinal, periarticular (elbow or knee).

(R) Residual Tumor (Postoperative) Grading

RX

Residual tumor cannot be assessed

R0

No residual tumor

R1

Microscopic residual tumor

R2

Macroscopic residual tumor

Residual tumor is always graded following resection, based on gross surgical as well as microscopic pathologic assessment. Depending on grade of tumor and residual tissue, chemotherapy &/or radiation therapy may be required to adequately or optimally treat the patient.

Χαρακτηριστικά Επέκτασης

• Generally hematogenous to lung & bone; rarely liver
• Regional lymph node involvement in osteosarcoma

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Variety of tissue types of 1° malignant bone tumor

• Most frequent is multiple myeloma; discussed in separate chapter
• Bone-forming: Osteosarcoma (OS); multiple subtypes
  • Conventional osteosarcoma
  • Parosteal osteosarcoma
  • Periosteal osteosarcoma
  • Telangiectatic osteosarcoma
  • Low-grade intraosseous osteosarcoma
  • High-grade surface osteosarcoma
  • Multicentric osteosarcoma
  • Secondary osteosarcoma

• Cartilage-forming
  • Chondrosarcoma
  • Dedifferentiated chondrosarcoma
• Fibrous
• Malignant fibrous histiocytoma (MFH)
• Fibrosarcoma
• Malignant giant cell tumor
• Adamantinoma
• Vascular: Angiosarcoma and other varieties
• Chordoma
• Ewing sarcoma
• Leukemia
• Lymphoma