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Bone Tumor Staging Systems

Author: Patrick O'Donnell

Topic updated on 03/12/13 10:14am

Introduction
Prognosis of bone cancer depends on the following variables
1. overall stage of disease (incorperates all of the below)
2. presence of metastasis
3. skip (discontinous) lesions within the same bone
4. histologic grade
5. tumor size
The are two staging systems that are commonly used:
MSTS or Enneking System
AJCC Staging System
MSTS (Enneking) Staging System
Introduction
most popular and useful for orthopaedic surgeons
two systems - one for malignant lesions and one for benign lesions
malignant lesions are defined using Roman numerals (e.g. I, II, III)
see table below
e.g. osteosarcoma most commonly presents as stage IIB
benign lesions are defined using Arabic numbers (1,2,3)
1 = latent lesion
e.g. non-ossifying fibroma
enchondroma
2 = active lesion
e.g. ABC, UBC
chondromyxoid fibroma
chondroblastoma
3 = aggressive lesion
e.g. giant cell tumor of bone
Stage

Grade

Site (1)

Metastasis

IA

Low Grade

T1 - intracompartmental

M0 (none)

IB

Low Grade

T2 - extracompartmental

M0 (none)

IIA

High Grade

T1 - intracompartmental

M0 (none)

IIB

High Grade

T2 - extracompartmental

M0 (none)

III

Metastatic

T1 - intracompartmental

M1 (regional or distant)

III

Metastatic

T2 - extracompartmental

M1 (regional or distant)

Tumor Compartments
intracompartmental
bone tumors are confined within the cortex of the bone
extracompartmental
bone tumors extend beyond the bone cortex
Tumor Grade
histologically, tumors are graded based on the percentage of cellular atypia
low grade tumors
low metastatic potential
e.g. parosteal osteosarcoma
high grade tumors
greater metastastatic potential
e.g. intramedullary osteosarcoma, Ewing's sarcoma, dedifferentiated
chondrosarcoma
AJCC Staging System
Stage

Grade

Size

Depth
any

Node
none

Metastasis
none

5 yr. survival

IA

Low Grade

< 8cm

98%

IB

Low Grade

> 8cm

IIA

High Grade

< 8cm

any

none

none

82%

IIB

High Grade

> 8cm

superficial

none

none

82%

none

III

any

discontinuous (skip) lesion deep

none

none

IVA

any

any

none

lung

IVB

any

any

present

other than
lung

any

52%

30%

Prognosis for soft tissue tumors depends on


grade
low grade: G1 and G2
high grade: G3 and G4
size
T1: < 8 cm
T2 > 8 cm
nodes
N0: no regional nodes
N1: regional nodes
metastasis
presence of distant metastasis automatically elevates patient to stage IV disease

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Qbank (1 Questions)
Question:

of 1Question:

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TAG

(OBQ05.7) A 13-year-old girl presents with an isolated distal femur osteosarcoma that extends into the soft tissue. Work-up is
negative for metastasis, but biopsy reveals a high grade lesion. What is the stage of this tumor by the Musculoskeletal Tumor
Society system?
Review Topic
1.
2.
3.
4.
5.

IA
II A
IB
II B
III

PREFERRED RESPONSE

Groups
Oral Boards: Bone Tumor Staging Systems
General - Oral Boards Review

Evidence & References Show References

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7/29/2011
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