Extent Of Local Tumour Spread

Border: pushing/infiltrative—an infiltrative margin is adverse. Lymphocytic reaction: prominent/sparse. Lymphatics/vessels/nerves including the proximal limit. Single/more than one anatomical compartment.

Soft tissue sarcoma

The TNM classification applies to alveolar soft part sarcoma, epithelioid sarcoma, extraskeletal chondro-/osteo-/Ewing's sarcomas/PNET, fibrosar-coma, leiomyosarcoma, liposarcoma, malignant fibrous histiocytoma, malignant haemangiopericytoma, malignant mesenchymoma, malignant peripheral nerve sheath tumour, rhabdomyosarcoma, synovial sarcoma and sarcoma, not otherwise specified. The following are excluded: angiosarcoma, Kaposi's sarcoma, dermatofibrosarcoma protuberans, fibromatosis and sarcomas arising from dura mater, brain, hollow viscera or parenchymatous organs except breast.

pT1 tumour <5 cm in greatest dimension a. superficial b. deep pT2 tumour >5 cm in greatest dimension a. superficial b. deep.

Superficial tumour is located exclusively above the superficial fascia. Deep tumour is located either exclusively beneath the superficial fascia or superficial to the fascia with invasion of or through the fascia. Retroperitoneal, mediastinal and pelvic sarcomas are deep.

Stage grouping also incorporates histological grade: localized non-metastatic lesions are stage I (low grade) or II (high grade). Stage III is localized, high-grade pT2b cancers and stage IV metastatic disease of any pT or histological grade.

pTI = tumour £ 8 cm pTIa = _ 5 cm dia, superficial pT2b = > 5 cm dia, deep pT2 = tumour > 8 cm Bone pTIa = _ 5 cm dia, superficial pT2b = > 5 cm dia, deep

Superficial fascia pTIb = _ 5cm dia, deep pT2a = > 5 cm dia, superficial

Soft tissues pT3 = discontinuous tumours in the primary bone site

Superficial fascia pTIb = _ 5cm dia, deep pT2a = > 5 cm dia, superficial

Soft tissues

Figure 36.1. Sarcoma. PA

Bone sarcoma

The TNM classification applies to all primary malignant bone tumours except malignant lymphomas, multiple myeloma, surface/juxtacortical osteosarcoma, and juxtacortical chondrosarcoma.

pT1 tumour <8 cm in greatest dimension pT2 tumour >8 cm in greatest dimension pT3 discontinuous tumours in the primary bone site pM1a lung metastasis pM1b other distant sites.

Metastasis in another bone is classified as distant metastasis. For pT1/pT2 optional descriptors are:

(i) beyond cortex to periosteum

(ii) beyond periosteum to surrounding soft tissues

(iii) with extension to major vessels or nerves.

Stage grouping also incorporates histological grade: localized non-metastatic pT1/pT2 lesions are either stage I (low grade) or II (high grade) and pT3 cancers are stage III (any grade). Stage IV is nodal or metasta-tic disease of any pT or histological grade. This is somewhat similar to the commonly used Enneking system, stage 3 of which combines TNM stage groups III and IV.

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