Gra a Ding Staging
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Transcript of Gra a Ding Staging
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GRADING AND STAGING OFTUMORS
Dr. Indri Windarti, Sp.PA
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GRADING
Degree of maturity or differentiationunder te mi!ro"!ope
#. $i"to%ogi! grade & re"em'%an!e 'et(een
tumor and norma% !e%%"). Nu!%ear grade & "i*e and "ape of
nu!%eu", di+iding !e%%"
.
Deraat maturita"dan diferen"ia"i "e%
#.$i"to%ogi! grade &'d"- -emiripan "e%tumor dgn "e%norma%
).Nu!%ear grade &u-uran dan 'entu-
inti, mito"i"
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TUMORGRADES
Mi!ro"!opi! apperan!e of !an!er !e%%" degree" of "e+erity
Grade/
G0 Grade !annot 'e a""e""ed 1Undeterminedgrade2
G# We%%3differentiated 14o( grade2
G) Moderate%y differentiated 1Intermediate
grade2G5 Poor%y differentiated 1$ig grade2
G Undifferentiated 1$ig grade2
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GRADINGSYSTEMS
Different for different type" of!an!er"
G%ea"on & pro"tate !an!er6%"ton36%%i" & 'rea"t !an!erFurman & -idney !an!er
G%ea"on"y"tem
Furman "y"tem
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GRADING TREATMENT
For treatment and progno"i"
4o(er grade
'etter progno"i" 1out!ome of diea"e2$iger grade (or"e progno"i"
Important in treatment of prim. 'rain tumor"1a"tro!ytoma"2,%ympoma", 'rea"t !an!er,
pro"tate
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STAGING
Per%ua"an tumor primer danpenye'arannya -e 'agian tu'u
7egunaan/
3 meren!ana-an pengo'atan
3 e"tima"i progno"i"
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Staging klinis
Ti" i" an e"timate of o( mu! !an!ertere i" 'a"ed on te py"i!a% e8am,imaging te"t" 183ray", 9T "!an", et!.2, andtumor 'iop"ie".
For "ome !an!er", te re"u%t" of oter te"t","u! a" '%ood te"t", are a%"o u"ed in "taging.
Te !%ini!a% "tage i" a -ey part of de!idingte 'e"t treatment to u"e.
It:" a%"o te 'a"e%ine u"ed for !ompari"on(en %oo-ing at te !an!er:" re"pon"e to
treatment.
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Pato%ogi!a% "taging 1a%"o !a%%ed "urgi!a% "taging2re%ie" on (at i" %earned a'out te !an!er during
"urgery.Often ti" i" "urgery to remo+e te !an!er and
near'y %ymp node", 'ut "ometime" "urgery may'e done to u"t %oo- at o( mu! !an!er i" in te'ody and ta-e out ti""ue "amp%e".
In "ome !a"e", te pato%ogi! "tage may 'edifferent from te !%ini!a% "tage 1for in"tan!e, if te"urgery "o(" te !an!er a" "pread more tan it(a" tougt to a+e "pread 'efore "urgery2.
Te pato%ogi!a% "tage gi+e" te ea%t !are teammore pre!i"e information tat !an 'e u"ed topredi!t treatment re"pon"e and out!ome"1progno"i"2.
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STAGING SYSTEMS
No uni;ue "taging "y"tem
Common elements / 3 4o!ation of te primary tumor
3 Tumor "i*e and num'er of tumor"
3 4ymp node in+o%+ement 1"pread of!an!er into %ymp node"2
3 Pre"en!e or a'"en!e of meta"ta"i"
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TNM - sstem
Mo"t !ommon 1a!!epted 'y UI99, A
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Primary Tumor (T)
TX Primary tumor cannot be evaluated
T0 No evidence of primary tumor
Tis Carcinoma in situ (has not spread) T1, T, T!, T" #i$e and%or e&tent of the primary tumor
Regional Lymph Nodes (N)
NX 'eional lymph nodes cannot be evaluated
N0 No reional lymph node involvement
N1, N, N! nvolvement of reional lymph nodes (number
and%or e&tent of spread)
Distant Metastasis (M)
*X +istant metastasis cannot be evaluated
*0 No distant metastasis*1 +istant metastasis (cancer has spread to distant parts
of the body)staging
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6a! !an!er type a" it" o(n +er"ion of ti"!%a""ifi!ation "y"tem, "o %etter" and num'er"
don:t a%(ay" mean te "ame ting for e+ery-ind of !an!er.
For e8amp%e, in "ome type" of !an!er T# mean"te tumor i" "ma%%er tan a !entimeter, 'ut in
anoter type a T# may 'e up to ) !entimeter".In "ti%% anoter !an!er type, T may te%% o( far
te !an!er a" in+aded into te %ayer" of ti""ue.
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OT$ER C%ASSI&ICATION
nn rbour lymphomas
+u-e.s classificationcolon cancer
/reslo scale and Clar-.s levelmelanoma
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Py"i!a% e8am"
e8amination, %oo-ing,
%i"tening
Imaging "tudie" 03ray,
US, 9T, MRI, P6T4a'oratory te"t" '%ood,
urine, AST>A4T, tumor
mar-er" 19A#?3?,9A#?3
@.2Pato%ogy report"
'iop"y, !yto%ogy
Surgi!a% report"
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'"estions(