Last Modified: 10/21/2011
Stage Information for Adult Soft Tissue Sarcoma
Definitions of TNM and Grade
Current Clinical Trials
Note: This stage information section has been updated to include information from the seventh edition (2010) of the American Joint Committee on Cancer’s AJCC Cancer Staging Manual. The PDQ Adult Treatment Editorial Board, which is responsible for maintaining this summary, is currently reviewing the new staging categories to determine whether additional changes need to be made to other parts of the summary. Any necessary changes will be made as soon as possible.
Staging has an important role in determining the most effective treatment of soft tissue sarcomas. The stage is determined by the size of the tumor, the histologic grade, and whether it has spread to lymph nodes or distant sites. Intracompartmental or extracompartmental extension of extremity sarcomas is also important for surgical decision making. For complete staging, a thorough physical examination, x-rays, laboratory studies, and careful review of all biopsy specimens (including those from the primary tumor, lymph nodes, or other suspicious lesions) are essential. Computed tomographic scan of the chest is recommended for sarcomas larger than 5 cm (T2) or with moderate to poor differentiation (grades 2–4). Nodal involvement is rare, occurring in less than 3% of patients with sarcoma.[1]
The American Joint Committee on Cancer (AJCC) has designated staging by the four criteria of tumor size, nodal status, grade, and metastasis (TNGM).[2]
Definitions of TNM and GradeTable 1. Primary Tumor (T)a,b
| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| T1 | Tumor ≤5 cm in greatest dimension. |
| T1a | Superficial tumor.b |
| T1b | Deep tumor.b |
| T2 | Tumor >5 cm in greatest dimension.b |
| T2a | Superficial tumor.b |
| T2b | Deep tumor. |
| aReprinted with permission from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. | |
| bSuperficial tumor is located exclusively above the superficial fascia without invasion of the fascia; deep tumor is located either exclusively beneath the superficial fascia, superficial to the fascia with invasion of or through the fascia, or both superficial yet beneath the fascia. |
Table 2. Regional Lymph Nodes (N)a
| NX | Regional lymph nodes cannot be assessed. |
| N0 | No regional lymph node metastasis. |
| N1b | Regional lymph node metastasis. |
| aReprinted with permission from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. | |
| bPresence of positive nodes (N1) in M0 tumors is considered Stage III. |
Table 3. Distant Metastasis (M)a
| aReprinted with permission from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 4. Anatomic Stage/Prognostic Groupsa
| aReprinted with permission from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. | ||||
| Stage IA | T1a | N0 | M0 | G1, GX |
| T1b | N0 | M0 | G1, GX | |
| Stage IB | T2a | N0 | M0 | G1, GX |
| T2b | N0 | M0 | G1, GX | |
| Stage IIA | T1a | N0 | M0 | G2, G3 |
| T1b | N0 | M0 | G2, G3 | |
| Stage IIB | T2a | N0 | M0 | G2 |
| T2b | N0 | M0 | G2 | |
| Stage III | T2a, T2b | N0 | M0 | G3 |
| Any T | N1 | M0 | Any G | |
| Stage IV | Any T | Any N | M1 | Any G |
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with adult soft tissue sarcoma 5. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 6.
References
- Fong Y, Coit DG, Woodruff JM, et al.: Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 217 (1): 72-7, 1993. [PUBMED Abstract]
- Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-6.