Examples of Assigning Summary Stage

Example 1: Breast

Patient presents for routine mammogram. Mammogram showed 1.5 cm mass. Ultrasound confirmed mass. Needle core biopsy showed invasive ductal carcinoma. No evidence of DCIS. No evidence of lymph node involvement on clinical exam.

Patient had lumpectomy and sentinel lymph node biopsy. Pathological reports 1.3 cm mass confined to breast, 0/2 SLN’s.

Summary Stage 2018: 1

Any size tumor confined to breast, negative lymph nodes. No mention of metastatic disease.

Example 2: Breast

Patient noticed lump in breast. Palpated by physician on clinical exam. Mammogram and ultrasound show 4 cm mass with clinically enlarged axillary nodes. Biopsy done which shows lobular carcinoma. Neoadjuvant therapy given.

After neoadjuvant therapy, patient had mastectomy and lymph node resection, which shows 3.8 cm tumor and 6/17 lymph nodes.

Summary Stage 2018: 3

Localized tumor (any size tumor confined to breast) with positive lymph nodes.

Example 3: Prostate

Patient noted to have elevated PSA during routine annual exam. Presented for prostate biopsy, which showed adenocarcinoma, Gleason score 3+4=7. On DRE, nodules noted in both lobes. Patient opted for prostatectomy.

Prostatectomy revealed adenocarcinoma, Gleason 3+4=7, extracapsular extension noted in right lobe, 0/4 lymph nodes.

Summary Stage 2018: 2

Regional tumor, extracapsular extension (unilateral, bilateral, or NOS).

Example 4: Lung

CT scan, RLL nodule, 1.9 cm mass, with suspicious evidence of mediastinal adenopathy. PET scan shows uptake in the lung mass and nodes.

Surgical resection reveals 1.6 cm mass with extension into the pleura, 0/8 lymph nodes involved.

Summary Stage 2018: 2

Regional tumor, pleura involvement.

Example 5: Colon and Rectum

Patient presents with abdominal discomfort. CT chest, abdomen and pelvis done, showing a mass in the ascending colon. Multiple lesions noted in the liver, suspicious for metastatic tumor.

Surgical resection shows 5.6 cm mass in ascending colon extending to the serosa. Lymph node resection shows 8/16 mesenteric and paracolic lymph nodes. Liver biopsy positive for metastases.

Summary Stage 2018: 7

For ascending colon, involvement of the liver is regional if there is direct (contiguous) extension from the ascending colon to the liver. For this case, there is no evidence of direct extension, so the involvement of the liver is metastatic.

Example 6: HemeRetic (Hematopoietic neoplasms, including Leukemias)

Bone marrow biopsy shows acute myeloid leukemia.

Summary Stage 2018: 7

All leukemias are Summary Stage 7 since they are systemic by definition.

Updated: December 15, 2023