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Clinical Article
Orthopaedic oncology Generic structured oral examination question 3: Staging
## EXAMINER : So what stage is this tumour?
CANDIDATE : I would stage this tumour using the Musculoskeletal Tumour Society staging system as described
## Table 7.1 Enneking/MSTS staging system.2
| ## Stage | ## Description | ## Grade | ## Site | ## Metastases |
|---|---|---|---|---|
| ## IA | ## Low-grade, intracompartmental | ## G1 | ## T1 | ## M 0 |
| ## IB | ## Low-grade, extracompartmental | ## G1 | ## T2 | ## M 0 |
| ## IIA | ## High-grade, intracompartmental | ## G2 | ## T1 | ## M 0 |
| ## IIB | ## High-grade, extracompartmental | ## G2 | ## T2 | ## M 0 |
| ## III | ## Any grade,metastatic | ## G1–2 | ## T1–2 | ## M 1 |
| ## ## | ||||
| ## by Enneking.1 We have discussed that it is a high-grade osteosarcoma, which makes it at least Stage II. It’s an intramedullary tumour that has invaded the surrounding soft- tissues making it extracompartmental, and upstaging it to IIB. We’ve not discussed whether there is any evidence of metastasis yet, but, if there is, that would immediately make it a Stage III, regardless of the other features we’ve talked about. | ||||
| ## General advice: This question will usually follow a discussion about a malignant tumour, for example osteosarcoma as in this example. The Enneking system (Table 7.1) is the easiest to remember and can be applied equally to bony and soft-tissue sarco- mas.2 The other commonly used system is the Ameri- can Joint Committee on Cancer (AJCC) system, which is more complicated. The AJCC also have separate systems for bony and soft-tissue tumours. | ||||
| ## 1. ## Enneking WF, Spanier SS, Goodman MA. Current concepts review. The surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am 1980;62-A:1027–1030. | ||||
| 2. ## NCCN. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma. V.2.2008. National Comprehensive Cancer Network, 2008. | ||||
| ## Orthopaedic | ||||
| ## Orthopaedic oncology Generic structured oral examination question 3: Staging |
## EXAMINER : So what stage is this tumour?
CANDIDATE : I would stage this tumour using the Musculoskeletal Tumour Society staging system as described
## Table 7.1 Enneking/MSTS staging system.2
| ## Stage | ## Description | ## Grade | ## Site | ## Metastases |
|---|---|---|---|---|
| ## IA | ## Low-grade, intracompartmental | ## G1 | ## T1 | ## M 0 |
| ## IB | ## Low-grade, extracompartmental | ## G1 | ## T2 | ## M 0 |
| ## IIA | ## High-grade, intracompartmental | ## G2 | ## T1 | ## M 0 |
| ## IIB | ## High-grade, extracompartmental | ## G2 | ## T2 | ## M 0 |
| ## III | ## Any grade,metastatic | ## G1–2 | ## T1–2 | ## M 1 |
| ## ## | ||||
| ## by Enneking.1 We have discussed that it is a high-grade osteosarcoma, which makes it at least Stage II. It’s an intramedullary tumour that has invaded the surrounding soft- tissues making it extracompartmental, and upstaging it to IIB. We’ve not discussed whether there is any evidence of metastasis yet, but, if there is, that would immediately make it a Stage III, regardless of the other features we’ve talked about. | ||||
| ## General advice: This question will usually follow a discussion about a malignant tumour, for example osteosarcoma as in this example. The Enneking system (Table 7.1) is the easiest to remember and can be applied equally to bony and soft-tissue sarco- mas.2 The other commonly used system is the Ameri- can Joint Committee on Cancer (AJCC) system, which is more complicated. The AJCC also have separate systems for bony and soft-tissue tumours. | ||||
| ## 1. ## Enneking WF, Spanier SS, Goodman MA. Current concepts review. The surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am 1980;62-A:1027–1030. | ||||
| 2. ## NCCN. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma. V.2.2008. National Comprehensive Cancer Network, 2008. | ||||
| ## ## |
