Staging
Accurate staging of human malignancy is often the best predictor of outcome and aids practitioners in decision making with regard to treatment and patient counseling. Uniform staging also provides a language by which to describe a given type of cancer to
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Staging Sherrif F. Ibrahim and Siegrid S. Yu
Introduction The American Joint Committee on Cancer (AJCC) defines staging as the process of determining how much cancer there is in the body and where it is located [1]. The philosophy of cancer classification and staging draws from the premise that cancers of the same anatomic site and histology share similar patterns of growth and clinical outcomes. The staging of various human malignancies is of critical importance for several reasons. Tumor staging can be a clinically useful tool for therapeutic decision-making, estimation of prognosis, and evaluation of treatment results. Standardized staging is also critical as a means of communication and collaborative scientific investigation. Accurate staging provides the practitioner with the best road map for treatment. If certain workups or therapies have been shown to be more beneficial for certain stages, then consistent S.F. Ibrahim (*) Department of Dermatology, University of Rochester Medical Center, 400 Red Creek Drive, Suite 200, Rochester, NY 14623, USA e-mail: [email protected] S.S. Yu Department of Clinical Dermatology, UCSF Dermatologic Surgery & Laser Center, 1701 Divisadero Street, Third Floor, San Francisco, CA 94115-0316, USA e-mail: [email protected]
staging allows a physician to make optimal management decisions that are rooted in the collective experiences of similar cases around the world. Stage at presentation often provides the best prognostic factor for survival, determines course of treatment, and allows for consistent and systematic reporting of data, as it is a standardized means by which to describe the extent of involvement and severity of a given cancer. When a patient is newly diagnosed with cancer, his or her first response is commonly, “how long do I have?” Without accurate staging, this question becomes impossible to answer. Consensus staging methods allow the practitioner to reply with a response based upon the best available knowledge, which is determined from the collective reported literature and expected course of a given type of cancer. Furthermore, a uniform and reproducible staging system provides practitioners with a common language by which to discuss specific details of a given patient’s tumor both with the patient and with other health care professionals. In the case of Merkel cell carcinoma (MCC) and other rare tumors, cases are so few in number that studies in the literature tend to be retrospective in nature. Without a comprehensive, uniformly adopted staging system based upon factors that provide proven useful prognostic information, evaluations that compare various studies and metaanalyses that group data from multiple studies are difficult, if not impossible. The evolution of MCC staging is outlined below.
M. Alam et al. (eds.), Merkel Cell Carcinoma, DOI 10.1007/978-1-4614-6608-6_4, © Springer Science+Business Media New York 2013
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S.F. Ibrahim and S.S. Yu
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Staging of Merkel Cell Carcinoma To date, six staging systems for MCC have been published, t
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