Osteosarcoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

Overview

According to the American Joint Committee on Cancer (AJCC), there are four stages of osteosarcoma based on the size of primary tumor, metastasis, involvement of lymph nodes, and grade of the tumor. For the purpose of treatment, there are only two stages of high-grade osteosarcoma: localized osteosarcoma and metastatic osteosarcoma.

Staging

• Historically, the Enneking staging system for skeletal malignancies was widely used.
• This system inferred the aggressiveness of the primary tumor by the descriptors intracompartmental or extracompartmental.
• The American Joint Committee on Cancer (AJCC) staging system for malignant bone tumors has updated this staging system, substituting compartmentalization with size.
• The International Union Against Cancer (UICC) uses the TNM system to describe the extent of many solid tumor cancers.
• For the purpose of treatment, there are only two stages of high-grade osteosarcoma:

Localized osteosarcoma:

• Localized tumors are limited to the bone of origin.
• Patients with skip lesions confined to the bone that includes the primary tumor are considered to have localized disease if the skip lesions can be included in the planned surgical resection.

Metastatic osteosarcoma:

• Patients in whom it is possible to detect any site of metastasis at the time of initial presentation by routine clinical studies are considered to have metastatic osteosarcoma.

TNM Staging system

TNM stands for tumor, nodes, metastasis. TNM staging describes:

• The size and extent of the primary tumor.
• The number and location of any regional lymph nodes that have cancer cells in them.
• Whether the cancer has spread or metastasized to another part of the body.

TNM staging of osteosarcoma

Stage	Tumor Grade	Tumor Size
IA	Low	The tumor is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
IB	Low	The tumor is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
IIA	High	The tumor is 8 cm or less in size. It has not spread to lymph nodes or distant sites of the body.
IIB	High	The tumor is more than 8 cm in size. It has not spread to lymph nodes or distant sites of the body.
III	Any tumor grade, skip metastases.
IV	Any tumor grade, any tumor size, distant metastases.