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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tumors in the fourth edition of the AJCC Manual for Staging of Cancer based heavily on the tumor grade, but this was withdrawn in subsequent editions.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
| 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 |
| 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 |
| 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: Adrenal (suprarenal): Thyroid Thyroid cartilage |
| 60 |
Pituitary and craniopharyngeal duct: Cavernous sinus Infundibulum Pons Sphenoid body and sinuses Pineal: 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 |