Staging-trunk and extremities

Soft tissue

General

Authors: Faizan Malik, M.B.B.S., Michael R. Clay, M.D.

Editor-in-Chief: Debra Zynger, M.D.

Topic Completed: 1 November 2018

Minor changes: 14 July 2020

Copyright: 2018-2019, PathologyOutlines.com, Inc.

PubMed Search: Staging soft tissue sarcomas of trunk and extremities

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Table of Contents

Cite this page: Malik F, Clay MR. Staging-trunk and extremities. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/softtissuestagingtrunkextremities.html. Accessed August 14th, 2020.

Pathologic TNM staging of sarcomas of the trunk and extremities, AJCC 8th edition

Introduction

Sarcomas not staged according to this staging system include desmoid tumor (deep fibromatosis) and Kaposi sarcoma
Breast is considered a trunk site; breast sarcomas and phyllodes tumors should be staged according to this staging system
Embryonal and alveolar rhabdomyosarcomas are staged according to pediatric guidelines
Neurovascular and bone invasion is not included as a determinant of stage; however, it should be reported whenever possible

Primary tumor (pT)

pTX: Primary tumor cannot be assessed
pT0: No evidence of primary tumor
pT1: Tumor ≤ 5 cm in greatest dimension
pT2: Tumor > 5 cm and ≤ 10 cm in greatest dimension
pT3: Tumor > 10 cm and ≤ 15 cm in greatest dimension
pT4: Tumor > 15 cm in greatest dimension

Notes:

Largest tumor diameter (in any plane) should be measured
Special consideration should be given to tumors that may have tail-like projections, such as undifferentiated pleomorphic sarcoma and myxofibrosarcoma
Surrounding edema, if present, should be excluded from size measurement

Regional lymph nodes (pN)

pN0: No regional lymph node involvement
pN1: Regional lymph node metastasis

Notes:

pNX is not used for soft tissue tumors and no pN should be reported if no lymph nodes are present

Distant metastasis (pM)

pM1: Distant metastasis

Histologic grade (G)

GX: Grade cannot be assessed
G1: Total differentiation, mitotic count and necrosis score of 2 or 3
G2: Total differentiation, mitotic count and necrosis score of 4 or 5
G3: Total differentiation, mitotic count and necrosis score of 6, 7 or 8

AJCC prognostic stage groups

AJCC stage	Stage grouping	Trunk and extremities sarcoma stage
IA	T1	Cancer is ≤ 5 cm (2 in) (T1)
	N0	It has not spread to nearby lymph nodes (N0)
	M0	It has not spread to distant sites (M0)
	G1 or GX	Cancer is grade 1 (G1) or the grade cannot be assessed (GX)
IB	T2, T3, T4	Cancer is > 5 cm but ≤ 10 cm (T2) OR > 10 cm but ≤ 15 cm (T3) OR > 15 cm (T4)
	N0	It has not spread to nearby lymph nodes (N0)
	M0	It has not spread to distant sites (M0)
	G1 or GX	Cancer is grade 1 (G1) or the grade cannot be assessed (GX)
II	T1	Cancer is ≤ 5 cm (2 in) (T1)
	N0	It has not spread to nearby lymph nodes (N0)
	M0	It has not spread to distant sites (M0)
	G2 or G3	Cancer is grade 2 (G2) or grade 3 (G3)
IIIA	T2	Cancer is > 5 cm but ≤ 10 cm (T2)
	N0	It has not spread to nearby lymph nodes (N0)
	M0	It has not spread to distant sites (M0)
	G2 or G3	Cancer is grade 2 (G2) or grade 3 (G3)
IIIB	T3 or T4	Cancer is > 10 cm but ≤ 15 cm (T3) OR > 15 cm (T4)
	N0	It has not spread to nearby lymph nodes (N0)
	M0	It has not spread to distant sites (M0)
	G2 or G3	Cancer is grade 2 (G2) or grade 3 (G3)
IV	Any T	Cancer is any size (any T) AND
	N1	It has spread to nearby lymph nodes (N1)
	M0	It has not spread to distant sites (M0)
	Any G	It can be any grade
	OR
	Any T	Cancer is any size (any T) AND
	Any N	It has or has not spread to nearby lymph nodes (any N)
	M1	It has spread to distant sites such as the lungs (M1)
	Any G	It can be any grade

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