Common Concerns for Staging
Some common concerns about staging are the following:
- The stage of a cancer is sometimes confused with the grade of a tumor by new registrars. Terms such as well differentiated and undifferentiated are tumor grades.
- The rules for each staging scheme must be reviewed for each site and histology. The AJCC staging systems and summary staging systems list the sites and histologies to which specific staging schemes apply.
- The term microinvasion implies invasion through the basement membrane (an anatomic landmark), indicating that the stage is invasive instead of in-situ.
- Some cases of cancer are difficult to stage appropriately. Problem situations include the following:
- Diagnostic tests done on an outpatient basis with results not documented in the hospital health information record
- Tests and biopsies done in a physician's office and sent to freestanding laboratories for assessment
- Conflicting information about the exact location, size, and involvement of the tumor
There are many resources available for staging cancers. The registry should have adequate access to appropriate references. Staging manuals for the most commonly used systems (summary staging, AJCC staging, and SEER extent of disease) provide comprehensive guidelines. These should be routinely reviewed at the time of abstracting to verify the staging classification.
The Commission on Cancer of the American College of Surgeons requires that staging be done by the managing physician and recorded in the patient's health information record. This requirement does not negate the need for the registrar to understand staging. Verification is necessary at the registry level to ensure the accuracy and completeness of data. It is imperative that staging be correct, when registry data are reported and analyzed.
The patient's treatment is based on the extent of the disease. The prognosis of the disease can be estimated by the stage and other factors such as age, aggressiveness of tumor, and the presence or absence of other medical conditions. In certain stages of disease, quality of life issues may influence treatment decisions. The stage of disease is used in research studies and in the analysis of cancers.