Updated: 6/18/2021

Bone Tumor Staging Systems

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  • Introduction
    • Prognosis of bone cancer depends on the following variables
      1. overall stage of disease (incorporates all of the below)
      2. presence of metastasis
      3. skip (discontinous) lesions within the same bone
      4. histologic grade
      5. tumor size
    • The are two staging systems that are commonly used:
      • MSTS or Enneking System
      • AJCC Staging System
  • MSTS (Enneking) Staging System
    • Introduction
      • most popular and useful for orthopaedic surgeons
      • two systems - one for malignant lesions and one for benign lesions
        • malignant lesions are defined using Roman numerals (e.g. I, II, III)
          • see table below
          • e.g. osteosarcoma most commonly presents as stage IIB
        • benign lesions are defined using Arabic numbers (1,2,3)
          • 1 = latent lesion
            • e.g. non-ossifying fibroma
            • enchondroma
          • 2 = active lesion
            • e.g. ABC, UBC
            • chondromyxoid fibroma
            • chondroblastoma
          • 3 = aggressive lesion
            • e.g. giant cell tumor of bone
        • MSTS Staging for Malignant tumors
        • Stage
        • Grade
        • Site
        • Metastasis
        • IA
        • Low Grade
        • T1 - intracompartmental
        • M0 (none)
        • IB
        • Low Grade
        • T2 - extracompartmental
        • M0 (none)
        • IIA
        • High Grade
        • T1 - intracompartmenta
        • M0 (none)
        • IIB
        • High Grade
        • T2 - extracompartmental
        • M0 (none)
        • III
        • Metastatic
        • T1 or T2 - intra or extra-compartmental
        • M1 (regional or distant)
    • Tumor Compartments
      • intracompartmental
        • bone tumors are confined within the cortex of the bone
      • extracompartmental
        • bone tumors extend beyond the bone cortex
    • Tumor Grade
      • histologically, tumors are graded based on the percentage of cellular atypia
        • low grade tumors
          • low metastatic potential
          • e.g. parosteal osteosarcoma
        • high grade tumors
          • greater metastastatic potential
          • e.g. intramedullary osteosarcoma, Ewing's sarcoma, dedifferentiated chondrosarcoma
  • AJCC Staging System
      • AJCC Staging System
      • Stage
      • Grade
      • Size
      • Depth
      • Node
      • Metastasis
      • 5 yr. survival
      • IA
      • Low Grade
      • < 8cm
      • Any
      • None
      • None
      • 98%
      • IB
      • Low Grade
      • > 8cm
      • Any
      • None
      • None
      • IIA
      • High Grade
      • < 8cm
      • Any
      • None
      • None
      • 82%
      • IIB
      • High Grade
      • > 8cm
      • Superficial
      • None
      • None
      • 82%
      • III
      • Any
      • Discontinuous (skip) lesion
      • Deep
      • None
      • None
      • 52%
      • IVA
      • Any
      • Any
      • Any
      • None
      • Lung
      • IVB
      • Any
      • Any
      • Any
      • Present
      • Other than lung
      • 30%
    • Prognosis for soft tissue tumors depends on
      • grade
        • low grade: G1 and G2
        • high grade: G3 and G4
      • size
        • T1: < 8 cm
        • T2 > 8 cm
      • nodes
        • N0: no regional nodes
        • N1: regional nodes
      • metastasis
        • presence of distant metastasis automatically elevates patient to stage IV disease

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(OBQ05.7) A 13-year-old girl presents with an isolated distal femur osteosarcoma that extends into the soft tissue. Work-up is negative for metastasis, but biopsy reveals a high grade lesion. What is the stage of this tumor by the Musculoskeletal Tumor Society system?

QID: 44
1

I A

0%

(3/1999)

2

II A

7%

(142/1999)

3

I B

3%

(55/1999)

4

II B

85%

(1693/1999)

5

III

5%

(96/1999)

L 1 D

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