Editing Soft tissue sarcoma (section)

== '''Staging''' ==

* See full staging criteria below
* Different criteria for retroperitoneal, extremities/trunk, head and neck, and abdomen and visceral organs
** Also separate criteria for GIST, bone sarcoma, uterine sarcoma Kaposi sarcoma, and dermatofibrosarcoma protuberans
* No known tumour markers
* Grade - see above - AJCC prefers FNCLCC system


'''Retroperitoneal soft tissue sarcoma TNM staging AJCC UICC 8th edition'''
{| class="wikitable"
|'''Primary tumor (T)'''
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|'''T category'''
|'''T criteria'''
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|TX
|Primary tumor cannot be assessed
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|T0
|No evidence of primary tumor
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|T1
|Tumor 5 cm or less in greatest dimension
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|T2
|Tumor more than 5 cm and less than or equal to 10 cm in greatest dimension
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|T3
|Tumor more than 10 cm and less than or equal to 15 cm in greatest dimension
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|T4
|Tumor more than 15 cm in greatest dimension
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|'''Regional lymph nodes (N)'''
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|'''N category'''
|'''N criteria'''
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|N0
|No regional lymph node metastasis or unknown lymph node status
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|N1
|Regional lymph node metastasis
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|'''Distant metastasis (M)'''
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|'''M category'''
|'''M criteria'''
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|M0
|No distant metastasis
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|M1
|Distant metastasis
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|'''Definition of grade (G)'''
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|'''G'''
|'''G definition'''
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|GX
|Grade cannot be assessed
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|G1
|Total differentiation, mitotic count and necrosis score of 2 or 3
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|G2
|Total differentiation, mitotic count and necrosis score of 4 or 5
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|G3
|Total differentiation, mitotic count and necrosis score of 6, 7, or 8
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|'''Prognostic stage groups'''
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|'''When T is...'''
|'''And N is...'''
|'''And M is...'''
|'''And grade is...'''
|'''Then the stage group is...'''
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|T1
|N0
|M0
|G1, GX
|IA
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|T2, T3, T4
|N0
|M0
|G1, GX
|IB
|-
|T1
|N0
|M0
|G2, G3
|II
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|T2
|N0
|M0
|G2, G3
|IIIA
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|T3, T4
|N0
|M0
|G2, G3
|IIIB
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|Any T
|N1
|M0
|Any G
|IIIB
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|Any T
|Any N
|M1
|Any G
|IV
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|'''Tumor differentiation'''
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|Tumor differentiation is histology specific and is generally scored as follows:
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|'''Differentiation score'''
|'''Definition'''
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|1
|Sarcomas closely resembling normal adult mesenchymal tissue (eg, low-grade leiomyosarcoma)
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|2
|Sarcomas for which histologic typing is certain (eg, myxoid/round cell liposarcoma)
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|3
|Embryonal and undifferentiated sarcomas, sarcomas of doubtful type, synovial sarcomas, soft tissue osteosarcoma, Ewing sarcoma/primitive neuroectodermal tumor (PNET) of soft tissue
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|'''Mitotic count'''
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|In the most mitotically active area of the sarcoma, 10 successive high-power fields (HPF; one HPF at 400x magnification = 0.1734 mm2) are assessed using a 40x objective.
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|'''Mitotic count score'''
|'''Definition'''
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|1
|0 to 9 mitoses per 10 HPF
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|2
|10 to 19 mitoses per 10 HPF
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|3
|≥20 mitoses per 10 HPF
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|'''Tumor necrosis'''
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|Evaluated on gross examination and validated with histologic sections.
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|'''Necrosis score'''
|'''Definition'''
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|0
|No necrosis
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|1
|<50% tumor necrosis
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|2
|≥50% tumor necrosis
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|}


'''Soft tissue sarcoma of the extremities and trunk TNM staging AJCC UICC 8th edition'''
{| class="wikitable"
|'''Primary tumor (T)'''
|
|
|
|
|-
|'''T category'''
|'''T criteria'''
|
|
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|-
|TX
|Primary tumor cannot be assessed
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|-
|T0
|No evidence of primary tumor
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|-
|T1
|Tumor 5 cm or less in greatest dimension
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|T2
|Tumor more than 5 cm and less than or equal to 10 cm in greatest dimension
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|T3
|Tumor more than 10 cm and less than or equal to 15 cm in greatest dimension
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|T4
|Tumor more than 15 cm in greatest dimension
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|-
|'''Regional lymph nodes (N)'''
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|-
|'''N category'''
|'''N criteria'''
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|N0
|No regional lymph node metastasis or unknown lymph node status
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|N1
|Regional lymph node metastasis
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|'''Distant metastasis (M)'''
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|'''M category'''
|'''M criteria'''
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|M0
|No distant metastasis
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|M1
|Distant metastasis
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|-
|'''Definition of grade (G)'''
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|-
|'''G'''
|'''G definition'''
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|-
|GX
|Grade cannot be assessed
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|-
|G1
|Total differentiation, mitotic count and necrosis score of 2 or 3
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|-
|G2
|Total differentiation, mitotic count and necrosis score of 4 or 5
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|-
|G3
|Total differentiation, mitotic count and necrosis score of 6, 7, or 8
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|-
|'''Prognostic stage groups'''
|
|
|
|
|-
|'''When T is...'''
|'''And N is...'''
|'''And M is...'''
|'''And grade is...'''
|'''Then the stage group is...'''
|-
|T1
|N0
|M0
|G1, GX
|IA
|-
|T2, T3, T4
|N0
|M0
|G1, GX
|IB
|-
|T1
|N0
|M0
|G2, G3
|II
|-
|T2
|N0
|M0
|G2, G3
|IIIA
|-
|T3, T4
|N0
|M0
|G2, G3
|IIIB
|-
|Any T
|N1
|M0
|Any G
|IV
|-
|Any T
|Any N
|M1
|Any G
|IV
|-
|'''Tumor differentiation'''
|
|
|
|
|-
|Tumor differentiation is histology specific and is generally scored as follows:
|
|
|
|
|-
|'''Differentiation score'''
|'''Definition'''
|
|
|
|-
|1
|Sarcomas closely resembling normal adult mesenchymal tissue (eg, low-grade leiomyosarcoma)
|
|
|
|-
|2
|Sarcomas for which histologic typing is certain (eg, myxoid/round cell liposarcoma)
|
|
|
|-
|3
|Embryonal and undifferentiated sarcomas, sarcomas of doubtful type, synovial sarcomas, soft tissue osteosarcoma, Ewing sarcoma/primitive neuroectodermal tumor (PNET) of soft tissue
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|
|
|-
|'''Mitotic count'''
|
|
|
|
|-
|In the most mitotically active area of the sarcoma, 10 successive high-power fields (HPF; one HPF at 400x magnification = 0.1734 mm2) are assessed using a 40x objective.
|
|
|
|
|-
|'''Mitotic count score'''
|'''Definition'''
|
|
|
|-
|1
|0 to 9 mitoses per 10 HPF
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|
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|-
|2
|10 to 19 mitoses per 10 HPF
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|-
|3
|≥20 mitoses per 10 HPF
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|-
|'''Tumor necrosis'''
|
|
|
|
|-
|Evaluated on gross examination and validated with histologic sections.
|
|
|
|
|-
|'''Necrosis score'''
|'''Definition'''
|
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|-
|0
|No necrosis
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|1
|<50% tumor necrosis
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|2
|≥50% tumor necrosis
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|}
'''Soft tissue sarcomas arising in the abdominal and thoracic viscera TNM staging AJCC UICC 8th edition*'''
{| class="wikitable"
|'''Primary tumor (T)'''
|
|-
|'''T category'''
|'''T criteria'''
|-
|TX
|Primary tumor cannot be assessed
|-
|T1
|Organ confined
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|T2
|Tumor extension into tissue beyond organ
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|T2a
|Invades serosa or visceral peritoneum
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|T2b
|Extension beyond serosa (mesentery)
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|T3
|Invades another organ
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|T4
|Multifocal involvement
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|T4a
|Multifocal (two sites)
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|T4b
|Multifocal (three to five sites)
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|T4c
|Multifocal (>5 sites)
|-
|'''Regional lymph nodes (N)'''
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|-
|'''N category'''
|'''N criteria'''
|-
|N0
|No lymph node involvement or unknown lymph node status
|-
|N1
|Lymph node involvement present
|-
|'''Distant metastasis (M)'''
|
|-
|'''M category'''
|'''M criteria'''
|-
|M0
|No metastases
|-
|M1
|Metastases present
|}