Summary staging is based on the theory of cancer growth previously
described in Unit One, Section Three, "Disease Process
of Cancer." Summary staging is also called General Staging,
California Staging, SEER Staging. It is the most basic staging
system and is applicable to all anatomic sites (solid tumors,
not leukemias). Summary Staging uses all information available
in the medical record, clinical, and pathological. It is frequently
used by tumor registries, but not always understood by physicians.
There are limitations for the staging system: categories
are so broad that there is a wide variety of cases included;
detailed analysis of a case with specific characteristics
is sometimes not possible.
Listed below are the five main categories of Summary Staging:
1. Rule out distant disease first. If metastases can be
documented, there is no need to spend a great deal of time
identifying local or regional spread.
2. Carcinomas and melanomas are the only types of cancer
that can be classified as in situ. Sarcomas are never described
as in situ.
3. If there is any evidence of invasion, nodal involvement
or metastatic spread, the case is not in situ even if the
pathology report so states. This is a common error in staging
cervical cancer where the path report states that the cancer
is "in situ with microinvasion"--such a case would be staged
as localized.
4. In order for a lesion to be classified as localized,
it must not extend beyond the outer limits of the organ
and there must be no evidence of metastases anywhere else.
5. For carcinomas, if there are lymph nodes involved with
the tumor, the stage is at least regionalized.
6. If a specific chain of lymph nodes is not named and
there is no indication in the chart of its location, assume
that the nodes are regional.
7. If nodes, organs, or adjacent tissues are not specifically
mentioned in the description of the various categories,
attempt to cross-reference the term you have with those
outlined. If there is no match, assume the site in question
represents distant disease.
8. If there is not enough information in the record to
categorize a case, it must be recorded as unstageable.
