Correct staging of the different pediatric tumors is critical. A proper treatment plan has to be informed by the extent of disease.
There are unique staging systems for most of the solid tumors and these have evolved over time and continue to change.
These systems are based on the extent of disease:
Table: Staging Assessment using tumor extent
| T | Local spread of primary Tumor | Size of tumor |
| Are adjacent organs involved? | ||
| N | Lymph Node metastases |
Are draining lymph nodes involved? |
| M | Distant Hematogenous Metastases |
Lungs, liver and bones are often the site of distant metastatic disease in pediatric patients. |
Pediatric oncology uses additional factors to assess the extent and "severity" of disease, such as:
- Surgical factors:
- Did the tumor rupture during resection?
- Was the tumor completely resected?
- Was the tumor resected with microscopically positive disease?
- Is there remaining gross residual disease?
- Pathology - is an unfavorable pathological subtype present?
- Cytogenetics - is an unfavorable cytogenetic marker present?
These features are used sometimes to stratify patients into different "risk categories" and this determines treatment protocols.
For example :
