Prostate cancer staging: Difference between revisions

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__NOTOC__
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{{SCC}}
{{CMG}} {{AE}} {{SCC}} {{sali}}
{{Prostate cancer}}
{{Prostate cancer}}
==Overview==
==Overview==
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'''Evaluation of the (primary) tumor ('T')'''<ref name=”cancergov”>National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq</ref>
'''Evaluation of the (primary) tumor ('T')'''<ref name=”cancergov”>National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq</ref>


*'''TX''': cannot evaluate the primary [[tumor]]
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
*'''T0''': no evidence of tumor
|valign=top|
*'''T1''': tumor present, but not detectable clinically or with imaging
|+
**'''T1a''': tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons)
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|T}}
**'''T1b''': tumor was incidentally found in greater than 5% of prostate tissue resected
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
**'''T1c''': tumor was found in a [[needle biopsy]] performed due to an elevated serum [[prostate-specific antigen|PSA]]
|-
*'''T2''': the tumor can be felt (palpated) on examination, but has not spread outside the prostate
| style="padding: 5px 5px; background: #DCDCDC;" |TX
**'''T2a''': the tumor is in half or less than half of one of the prostate gland's two [[lobe]]s
| style="padding: 5px 5px; background: #F5F5F5;" |Cannot evaluate the primary [[tumor]]
**'''T2b''': the tumor is in more than half of one lobe, but not both
|-
**'''T2c''': the tumor is in both lobes
| style="padding: 5px 5px; background: #DCDCDC;" |T0
*'''T3''': the tumor has spread through the prostatic [[capsule]] (if it is only part-way through, it is still '''T2''')
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of tumor
**'''T3a''': the tumor has spread through the capsule on one or both sides
|-
**'''T3b''': the tumor has invaded one or both [[seminal vesicle]]s
| style="padding: 5px 5px; background: #DCDCDC;" |T1
*'''T4''': the tumor has invaded other nearby structures
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor present, but not detectable clinically or with imaging
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T1a
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor was incidentally found in less than 5% of prostate [[tissue]] resected (for other reasons)
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T1b
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor was incidentally found in greater than 5% of prostate tissue resected
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T1c
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor was found in a [[needle biopsy]] performed due to an elevated serum [[prostate-specific antigen|PSA]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T2
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor can be felt (palpated) on examination, but has not spread outside the prostate
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T2a
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor is in half or less than half of one of the prostate gland's two [[lobe]]s
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T2b
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor is in more than half of one lobe, but not both
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T2c
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor is in both lobes
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor has spread through the prostatic [[capsule]] (if it is only part-way through, it is still T2)
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3a
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor has spread through the [[capsule]] on one or both sides
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3b
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor has invaded one or both [[seminal vesicle]]s
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T4
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor has invaded other nearby structures
|}


It should be stressed that the designation "T2c" implies a tumor which is ''palpable'' in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but which are not palpable bilaterally should not be staged as T2c.
'''Evaluation of the regional lymph nodes ('N')'''
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |NX
| style="padding: 5px 5px; background: #F5F5F5;" |Cannot evaluate the regional [[lymph nodes]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |There has been no spread to the regional lymph nodes
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |There has been spread to the regional lymph nodes
|}


'''Evaluation of the regional lymph nodes ('N')'''
'''Evaluation of distant metastasis ('M')'''
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |There is no distant metastasis
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M1
| style="padding: 5px 5px; background: #F5F5F5;" |There is distant metastasis
|}


*'''NX''': cannot evaluate the regional [[lymph nodes]]
==UICC staging==
*'''N0''': there has been no spread to the regional lymph nodes
The [[UICC]] further groups the [[TNM]] data into the stages listed in the table below:<ref>{{Cite web | title =Stages of prostate cancer| url =http://www.cancer.ca/en/cancer-information/cancer-type/prostate/staging/?region=ab }}</ref>
*'''N1''': there has been spread to the regional lymph nodes
* '''Stage I'''
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T1, T2a
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] involves half a [[lobe]] or less
|}


'''Evaluation of distant metastasis ('M')'''
* '''Stage II'''
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T2b, T2c
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] involves more than half a lobe but is limited to the prostate
|}


*'''MX''': cannot evaluate distant [[metastasis]]
* '''Stage III'''
*'''M0''': there is no distant metastasis
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
*'''M1''': there is distant metastasis
|valign=top|
**'''M1a''': the cancer has spread to lymph nodes beyond the regional ones
|+
**'''M1b''': the cancer has spread to [[bone]]
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|T}}
**'''M1c''': the cancer has spread to other sites (regardless of bone involvement)
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] has spread beyond the prostatic [[capsule]] or into the [[bladder]] neck or [[seminal vesicles]]
|}


==UICC staging==
* '''Stage IV'''
The [[UICC]] further groups the [[TNM]] data into the stages listed in the table below.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 400px" align=center
[[File:XXXXX.png|thumb|none|400px|This image is provided by the Canadian Cancer Society.]]
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T4
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] has become fixed to adjoining structures like the [[rectum]] or [[pelvic wall]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |any T
| style="padding: 5px 5px; background: #DCDCDC;" |N1
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor has spread to regional [[lymph nodes]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |any T
| style="padding: 5px 5px; background: #DCDCDC;" |any N
| style="padding: 5px 5px; background: #DCDCDC;" |M1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor has spread to distant sites such as [[lungs]] or [[liver]]
|}


==References==
==References==
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[[Category:Urology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 05:17, 6 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Steven C. Campbell, M.D., Ph.D. Syed Musadiq Ali M.B.B.S.[2]

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Overview

Prostate cancer may be classified into several subtypes based on TNM system and UICC.

TNM staging

Evaluation of the (primary) tumor ('T')[1]

T Definition
TX Cannot evaluate the primary tumor
T0 No evidence of tumor
T1 Tumor present, but not detectable clinically or with imaging
T1a Tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons)
T1b Tumor was incidentally found in greater than 5% of prostate tissue resected
T1c Tumor was found in a needle biopsy performed due to an elevated serum PSA
T2 Tumor can be felt (palpated) on examination, but has not spread outside the prostate
T2a Tumor is in half or less than half of one of the prostate gland's two lobes
T2b Tumor is in more than half of one lobe, but not both
T2c Tumor is in both lobes
T3 Tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2)
T3a Tumor has spread through the capsule on one or both sides
T3b Tumor has invaded one or both seminal vesicles
T4 Tumor has invaded other nearby structures

Evaluation of the regional lymph nodes ('N')

N Definition
NX Cannot evaluate the regional lymph nodes
N0 There has been no spread to the regional lymph nodes
N1 There has been spread to the regional lymph nodes

Evaluation of distant metastasis ('M')

M Definition
M0 There is no distant metastasis
M1 There is distant metastasis

UICC staging

The UICC further groups the TNM data into the stages listed in the table below:[2]

  • Stage I
T N M Definition
T1, T2a N0 M0 Tumor involves half a lobe or less
  • Stage II
T N M Definition
T2b, T2c N0 M0 Tumor involves more than half a lobe but is limited to the prostate
  • Stage III
T N M Definition
T3 N0 M0 Tumor has spread beyond the prostatic capsule or into the bladder neck or seminal vesicles
  • Stage IV
T N M Definition
T4 N0 M0 Tumor has become fixed to adjoining structures like the rectum or pelvic wall
any T N1 M0 Tumor has spread to regional lymph nodes
any T any N M1 Tumor has spread to distant sites such as lungs or liver

References

  1. ↑ National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq
  2. ↑ "Stages of prostate cancer".

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