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Brain Tumor Staging

Basically, all brain tumors are considered localized unless they cross the midline or the tentorium or unless they are described as having "drop" metastases in the spinal cord.

There was a TNM staging for brain tumors in the fourth edition of the AJCC Manual for Staging of Cancer based heavily on the tumor grade, but this was withdrawn in subsequent editions.

Summary Staging 2000

Local

confined to:
one hemisphere in one part of brain (infra/supratentorial); meninges; invading/encroaching on ventricular system

Regional

crossing midline or tentorium invades bone, blood vessel, nerves, spinal cord

Distant

circulating cells in CSF; extension to nasal cavity, nasopharynx, posterior pharynx; outside CNS

TNM

None in 5th or 6th editions.

Collaborative Staging

The Collaborative Staging System uses two fields to code the extent of disease for tumors of the brain and cerebral meninges. The extension field includes a code for benign brain tumors to meet the needs of cases that will be reported as of 2004.

The Collaborative Staging code structure is based on what area of the brain is involved and how far the tumor has spread.

Collaborative Staging - Extension

CNS (C70.0, C71._)
Code Description
05 Benign brain tumors
10 Supratentorial tumor confined to:
Cerebral hemisphere (cerebrum) or meninges of cerebral hemisphere on one side:
Lobe(s): Frontal - Occipital - Parietal - Temporal
11 Infratentorial tumor confined to:
Cerebellum or meninges of cerebellum on one side:
Vermis: Lateral lobes - Median lobe of cerebellum
12 Infratentorial tumor confined to:
Brain stem or meninges of brain stem on one side:
Medulla oblongata - Midbrain (mesencephalon) - Pons - Hypothalamus - Thalamus
15 Confined to brain, NOS - Confined to meninges, NOS
20 Infratentorial tumor:
Both cerebellum and brain stem involved with tumor on one side
30 Confined to ventricles
Tumor invades or encroaches upon ventricular system
40 Tumor crosses the midline
Tumor involves contralateral hemisphere
Tumor involves corpus callosum (including splenium)
50 Supratentorial tumor extends infratentorially to involve cerebellum or brain stem
51 Infratentorial tumor extends supratentorially to involve cerebrum (cerebral hemisphere)
60 Tumor invades:
Bone (skull) - Major blood vessel(s) - Meninges (dura) - Nerves, NOS {Cranial nerves} - Spinal cord/canal
70 Circulating cells in cerebral spinal fluid (CSF)
Nasal cavity
Nasopharynx
Posterior pharynx
Outside central nervous system (CSF)
80 Further contiguous extension
95 No evidence of primary tumor
99 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
Other CNS (C71.1, C71.9, C72.0-C72.5, C72.8, C72.9)
Code Description
05 Benign brain tumors
10 Tumor confined to tissue or site of origin
30 Localized, NOS
40 Meningeal tumor infiltrates nerve
Nerve tumor infiltrates meninges (dura)
50 Adjacent connective/soft tissue
Adjacent muscle
60 Brain, for cranial nerve tumors
Major blood vessel(s)
Sphenoid and frontal sinuses (skull)
70 Brain except for cranial nerve tumors
Bone, other than skull—Eye
80 Further contiguous extension
95 No evidence of primary tumor
99 Unknown extension; Primary tumor cannot be assessed; Not documented in record
CNS (Endocrine) C75.1-C75.3 (from the Collab. Stage schema for Thymus, Adrenal (Suprarenal) Gland, and Other Endocrine Glands)
Code Description
00 In situ; non-invasive; intraepithelial
05 For C75.1 pituitary gland, C75.2 craniopharyngeal duct, and C75.3 pineal gland ONLY: Benign
10 Invasive carcinoma confined to gland of origin
30 Localized, NOS
40 Adjacent connective tissue
Adjacent organs/structures

Thymus and aortic body:
Organs/structures in mediastinum

Adrenal (suprarenal):
Kidney
Retroperitoneal structures

Parathyroid:
Thyroid
Thyroid cartilage
60 Pituitary and craniopharyngeal duct:
Cavernous sinus
Infundibulum
Pons
Sphenoid body and sinuses

Pineal:
Infratentorial and central brain

Carotid body:
Upper neck
80 Further contiguous extension
95 No evidence of primary tumor
Unknown extension
99 Primary tumor cannot be assessed
Not documented in patient record