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Staging of solid tumors outside the CNS

Many different cancer types have different staging systems. The general model is that more advanced disease is associated with metastases and more extensive infiltration of surrounding tissue. 


Neuroblastoma has traditionally been divided as follows:  

  • Stage 1 – Localized tumor that can be radically removed
  • Stage 2 – Unilateral tumor, not possible to remove radically and/or presence of ipsilateral lymph nodes
  • Stage 3 – Tumor or lymph node infiltration on both sides of the midline 
  • Stage 4 – Metastases to the bone, lymph nodes, bone marrow, liver, and other organs
  • Stage 4S – Child < 1 year with a small primary tumor and metastases (except for bone metastases) 

In future protocols, disease stage will be based on resectability (L1/L2), metastases (M/Ms), biological markers (n-myc/1p) and age > or < 18 months.

Wilms' tumor staging

  • Stage 1 – Localized to the kidney, can be removed radically
  • Stage 2 – Tumor growth outside the kidney, can be removed radically 
  • Stage 3 – Tumor growth outside the kidney, cannot be removed radically
  • Stage 4 – Metastases (most commonly the lungs)
  • Stage 5 – Tumor in both kidneys

Germ cell tumors

Staging of germ cell tumors varies.

Malignant liver tumors

Liver tumors are divided according to ”PRE-TREATMENT TUMOUR EXTENSION” (PRETEXT). This system is based the extent of liver involvement at the time of diagnosis. The liver is separated into 4 sections (8 segments) and the PRETEXT system is divided accordingly:

  • PRETEXT I – Only 1 section is involved
  • PRETEXT II – 2 neighboring sections are involved
  • PRETEXT III – 2 sections unadjacent to each other or 3 neighboring sections are involved
  • PRETEXT IV – All 4 sections involved

The patients are separated into standard risk and high risk groups based on the following:

  • Standard risk – PRETEXT  I-III, no extrahepatic tumor, no tumor rupture and <100.
  • High risk – PRETEXT IV with or without extrahepatic tumor and AFP > 100

Extrahepatic disease includes venous extension, tumor growth extending outside the liver, and distant metastases.


Stage for sarcoma is based on 3 different systems and sometimes multiple systems are used simultaneously. The most common are IRS, TNM and MSTS.


Group   Disease description 

Localized disease, completely removed.
a) limited to organ or muscle it originates from
b) infiltration outside the organ or muscle it originates from

No infiltration of regional lymph nodes


Limited or regional resection of three types:
a) tumor is removed, but microscopic remains are present, no infiltration of regional lymph nodes  
b) regional disease completely removed without microscopic remains where lymph nodes may be involved and/or where the tumor microscopically infiltrates a neighboring organ 
c) regional disease with infiltration of lymph nodes, removed but microscopic remains present

III Incomplete resection or biopsy with macroscopic remains
IV Metastases at the time of diagnosis

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