Carcinoid syndrome staging
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Carcinoid syndrome Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Carcinoid syndrome staging On the Web |
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American Roentgen Ray Society Images of Carcinoid syndrome staging |
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Risk calculators and risk factors for Carcinoid syndrome staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
Staging
Definitions of TNM
The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define neuroendocrine tumors:[1]
Neuroendocrine Tumors: Stomach
| T | Primary tumor |
|---|---|
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ/dysplasia (tumor size <0.5 mm), confined to mucosa |
| T1 | Tumor invades lamina propria or submucosa and ≤1 cm in size |
| T2 | Tumor invades muscularis propria or >1 cm in size |
| T3 | Tumor penetrates subserosa |
| T4 | Tumor invades visceral peritoneum (serosal) or other organs or adjacent structures |
| For any T, add (m) for multiple tumors |
| N | Regional Lymph Nodes |
|---|---|
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Regional lymph node metastasis |
| M | Distant Metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Distant metastasis |
Neuroendocrine Tumors: Duodenum/Ampulla/Jejunum/Ileum
| T | Primary tumor |
|---|---|
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| T1 | Tumor invades lamina propria or submucosa and size ≤1 cmb (small intestinal tumors); tumor ≤1 cm (ampullary tumors) |
| T2 | Tumor invades muscularis propria or size >1 cm (small intestinal tumors); tumor >1 cm (ampullary tumors) |
| T3 | Tumor invades through the muscularis propria into subserosal tissue without penetration of overlying serosa (jejunal or ileal tumors) or invades pancreas or retroperitoneum (ampullary or duodenal tumors) or into nonperitonealized tissues |
| T4 | Tumor invades visceral peritoneum (serosa) or invades other organs |
| For any T, add (m) for multiple tumors |
| N | Regional Lymph Nodes |
|---|---|
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Regional lymph node metastasis |
| M | Distant Metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Distant metastasis |
Neuroendocrine Tumors: Colon or Rectum
| T | Primary tumor |
|---|---|
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| T1 | Tumor invades lamina propria or submucosa and size ≤2 cm |
| T1a | Tumor size <1 cm in greatest dimension |
| T1b | Tumor size 1–2 cm in greatest dimension |
| T2 | Tumor invades muscularis propria or size >2 cm with invasion of lamina propria or submucosa |
| T3 | Tumor invades through the muscularis propria into the subserosa or into nonperitonealized pericolic or perirectal tissues |
| T4 | Tumor invades peritoneum or other organs |
| For any T, add (m) for multiple tumors |
| N | Regional Lymph Nodes |
|---|---|
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Regional lymph node metastasis |
| M | Distant Metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Distant metastasis |
Appendiceal Carcinoids
| T | Primary tumor |
|---|---|
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| T1 | Tumor ≤2 cm in greatest dimension |
| T1a | Tumor ≤1 cm in greatest dimension |
| T1b | Tumor >1 cm but not >2 cm |
| T2 | Tumor >2cm but not >4 cm or with extension to the cecum |
| T3 | Tumor >4 cm or with extension to the ileum |
| T4 | Tumor directly invades other adjacent organs or structures, e.g., abdominal wall and skeletal muscle |
| N | Regional Lymph Nodes |
|---|---|
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Regional lymph node metastasis |
| M | Distant Metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Distant metastasis |
Lung Carcinoid
% Please add the following required packages to your document preamble: % \usepackage{multirow} \begin{table}[] \centering \caption{My caption} \label{my-label} \begin{tabular}{ll} {\bf T} & {\bf Primary Tumor} \\ {\bf TX} & The main (primary) tumor can’t be assessed, or cancer cells were seen on sputum cytology or bronchial washings but no tumor can be found \\ {\bf T0} & There is no evidence of a primary tumor \\ {\bf Tis} & The cancer is found only in the top layers of cells lining the air passages. It has not invaded into deeper lung tissues. This stage is also known as carcinoma in situ \\ {\bf T1} & The tumor is no larger than 3 centimeters (cm) – slightly less than 1¼ inches – across. It has not reached the membranes that surround the lungs (visceral pleura), and it does not affect the main branches of the bronchi \\ {\bf T1a} & The tumor is 2 cm (about 4/5 of an inch) or less across \\ {\bf T1b} & The tumor is larger than 2 cm but not larger than 3 cm across \\ \multirow{2}{*}Template:\bf T2 & The tumor has 1 or more of the following features: \\
& It is larger than 3 cm but not larger than 7 cm across \\
{\bf T2a} & The tumor is 5 cm or less across but still larger than 3 cm \\ {\bf T2b} & The tumor is larger than 5 cm across but not larger than 7 cm \\ \multirow{6}{*}Template:\bf T3 & The tumor has 1 or more of the following features: \\
& It is larger than 7 cm across. \\
& It has grown into the chest wall, the breathing muscle that separates the chest from the abdomen (diaphragm), the membranes surrounding the space between the lungs (mediastinal pleura), or membranes of the sac surrounding the heart (parietal pericardium) \\
& It invades a main bronchus and is closer than 2 cm (about ¾ inch) to the carina, but it does not involve the carina itself \\
& It has grown into the airways enough to cause an entire lung to collapse or to cause pneumonia in the entire lung \\
& Two or more separate tumor nodules are present in the same lobe of a lung \\
\multirow{3}{*}Template:\bf T4 & The cancer has 1 or more of the following features: \\
& A tumor of any size has grown into the space between the lungs (mediastinum), the heart, the large blood vessels near the heart (such as the aorta), the windpipe, the esophagus (tube connecting the throat to the stomach), the backbone, or the carina \\
& Two or more separate tumor nodules are present in different lobes of the same lung
\end{tabular} \end{table}
Anatomic Stage/Prognostic Groups
Stomach, Duodenum/Ampulla/Jejunum/Ileum, and Colon or Rectum
| Stage | T | N | M |
|---|---|---|---|
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| IIA | T2 | N0 | M0 |
| IIB | T3 | N0 | M0 |
| IIIA | T4 | N0 | M0 |
| IIIB | Any T | N1 | M0 |
| IV | Any T | Any N | M1 |
Appendiceal Carcinoids
| Stage | T | N | M |
|---|---|---|---|
| I | T1 | N0 | M0 |
| II | T2, T3 | N0 | M0 |
| III | T4 | N0 | M0 |
| Any T | N1 | M0 | |
| IV | Any T | Any N | M1 |
Residual Tumor (R)
| Carcinoma and Carcinoid | |
|---|---|
| R0 | Complete resection, margins histologically negative; no residual tumor left after resection. |
| R1 | Incomplete resection, margins histologically involved, microscopic tumor remains after resection of gross disease (relevant to resection margins that are microscopically involved by tumor). |
| R2 | Incomplete resection, margins involved or gross disease remains. |
References
- ↑ Stage Information for GI Carcinoid Tumors . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#section/_163 (date). September 21, 2015