CANCER CLASSIFICATION AND GUIDELINES

Stages and Grades of Cancer: The stage of a cancer is a descriptor (usually numbers
I to IV) of how much the cancer has spread. Cancers can be staged in various
methods such as Ann Arbor staging, TNM staging, Roman Numeral Staging.

In transcription, the word stage and grade of cancer are not capitalized.

By rule with stage, Roman numerals are used, and with grade, Arabic numerals are
used.

If the stage has a subdivision, it is placed immediately after the roman numeral
without space. Subdivisions contain uppercased alphabet or Roman numerals only.
For example:
stage I
stage IIA
stage III3
stage IVB

grade 1
grade 4

Several classification systems have been developed depending upon the body areas
affected and the extent of tumor. These are as follows:
Roman Numeral Staging
This system uses numerals I, II, III, and IV to describe the progression of cancer.
Stage I cancers are localized to one part of the body.
Stage II cancers are locally advanced, as are Stage III cancers. Whether a cancer is
designated as Stage II or Stage III can depend on the specific type of cancer; for
example, in Hodgkin's Disease, Stage II indicates affected lymph nodes on only one
side of the diaphragm, whereas Stage III indicates affected lymph nodes above and
below the diaphragm. The specific criteria for Stages II and III therefore differ
according to diagnosis.
Stage IV cancers have often metastasized, or spread to other organs or throughout the
body.
TNM staging
TNM Staging is used for solid tumors, and is an acronym for the words Tumor, Nodes,
and Metastases. Each of these criteria is separately listed and paired with a number to
indicate the TNM stage. A T1N2M0 cancer would be a cancer with a T1 tumor, N2
involvement of the lymph nodes, and no metastases (no spreading through the body).

T (TI-T4): Tumor (T) refers to the primary tumor and carries a number of 0 to 4.
N (N1-N3): N represents regional lymph node involvement and can also be ranked
from 0 to 4.
M (M0-Ml): Metastasis is represented by the letter M, and is 0 if no metastasis has
occurred or 1 if metastases are present.

For example:
T2, N1, M0
TX, N0, M0

TNM classification makes use of staging indicators to define cancer and assess their
stage. Capital letters are used for staging followed by Arabic numeral without space.
These are:
Grade: GX, G 1, G2, G3
Host performance: HO, HI, H2, H3, H4
Lymphatic invasion: LX, La, L1, L2
Residual tumor: RX, RO, RI, R2
Scleral invasion: SO, Sl, S2
Venous invasion: VX, VA, VI, V2

Broders Index
Broders index is a classification used to report the aggressiveness of a malignant tumor. It
is reported in grades from 1 to 4, with grade 1 having best prognosis and grade 4 the
worst. Arabic numeral from 1 to 4 is used to specify the grade with grade being in lower
case.
For example: Broders grade 4.
CIN System
CIN stands for cervical intraepithelial neoplasia and is used to classify the lesions of the
cervical cancer. It is classified from 1 to 3 Arabic numerals, where
1 represents mild dysplasia (lower severity),
2 represents moderate dysplasia, and
3 represents severe dysplasia (maximum severity). To transcribe, place the grade
specified online with CIN with a hyphen joining the two.
For example: ClN-1
Clark Level
This classification is used to report level of invasion of the primary malignant melanoma
or the skin, arising from epidermis. Roman numeral from I to V are used to indicate the
invasion.
Clark level I limited to epidermis.
Clark level II into underlying papillary dermis.
Clark level III to junction of papillary and reticular dermis.
Clark level IV into reticular dermis
Clark level V into subcutaneous fat.
Dukes Classification
This classification is used to report the extent of operable adenocarcinoma of the colon or
rectum. It is classified from A to C (uppercase alphabets).

Dukes A
Dukes B1:
Dukes B2:

confined to mucosa.
extends into muscularis mucosa.
extends through the muscularis mucosa.

Dukes C1:
Dukes C2:

limited to the bowel wall with metastasis to the lymph nodes.

extends through the bowel wall with metastasis to the lymph nodes.

Dukes is transcribed without apostrophe, (Dukes) and not (Duke's), with alphabet A, B,
or C on the same line. The Arabic numerals for subdivision of Band C are transcribed just
immediate after it without the space.
For example: Dukes C1
FAB Classification
It is a system of classification for acute leukemias, lymphocytic and myelogenous, where
FAB stands for French-American-British. This system utilizes FAB classification of
malignant tumors explained later in this section.
Acute lymphocytic leukemia is divided in three classes, and transcribed by placing
capital letter followed by Arabic numeral 1 through 3.

Small lymphoblasts with mature appearance

More immature than L1, with different nuclear shapes and sizes
Relatively large lymphoblasts

Acute myelogenous leukemia is classified from 0 to 7 (Arabic numerals). Upper case M

is to precede the numeral without a space.
M0:
M1:
M2:
M3:
M4:
M5:
M6:
M7:

undifferentiated
myeloblastic, with some immature cells
myeloblastic with differentiation of cells
promyelocytic
myelomonocytic
monocytic
erythroleukemia
megakaryocytic

FIGO Staging
It is a system of classification for staging of gynecologic cancers. FIGO stands for
Federation Internationale de Gynecologie et Obstetrique on the organization, which
developed it. It is expressed in stages 0 to IV with 0 being precancerous stage, and IV
being highly malignant and most severe. For subdivisions, upper case alphabets are used
without space from the division. For example: ovarian cancer, FIGO stage IIB.
Gleason Tumor Score
It is a classification system used for adenocarcinoma of the prostate gland. The score or

grade to determine the severity is reached at by totaling the score achieved on a scale of 1
to 5 for each dominant and secondary pattern. The higher the score, the severer is the
prognosis. Arabic numeral is used for the score with space between word grade and
score. For example: The patient has Gleason score 8.
Jewett and Strong Staging
It is a system used to classify extent of the bladder carcinoma, from class 0 to 0
depending upon the extent of invasion. Uppercased alphabets are used.
O:
A:
B:
C:
D:

non-invasive, in situ
invading submucosa
invading mucosa
invading surrounding tissue
lymph node metastasis

For example: The patient has bladder carcinoma, Jewett Class C.