Biopsy is needed to establish the diagnosis for primary - but not for metastatic sites (masses seen in liver or lung) except for bone marrow.
Staging prior to treatment requires
- Clinical examination
- Imaging studies
Pre-treatment size is part of the staging
- Measured on MRI or CT depending on location.
- Examination and CT can be used to assess lymph size.
- Metastatic sites will require some form.
Primary Tumor: TNM Staging of Rhabdomyosarcoma
T1 = Confined to anatomic site of origin
- a. ≤ 5 cm in diameter in size
- b. > 5 cm in diameter in size
T2 = Extension and/or fixative to surrounding tissue
- a. ≤ 5 cm in diameter in size
- b. > 5 cm in diameter in size.
Regional Nodes
N0 = Regional nodes not clinically involved
N1 = Regional nodes clinically involved by neoplasm
Nx = Clinical status of regional nodes unknown (especially sites where lymph node evaluation is not possible.
Metastasis
M0 = No distant metastasis
M1 = Distant metastasis present
TNM Staging depends on the tumor SITE.
Stage 1
- Head and neck (excluding parameningeal) GU
- Orbit
- Genitourinary (non-bladder/non-prostate) Biliary Tract
- Biliary Tract
- In addition these tumors must also be T1 or T2 (a or b), N0/1/x and M0
Stage 2
- Bladder / prostate
- Extremity
- Cranial parameningeal
- Other: trunk, retroperitoneum, etc
- In addition these tumors must also be T1 or T2 a (not b), N0 or Nx (not N1) and M0
Stage 3
- Bladder/Prostate
- Cranial parameningeal
- Other: trunk, retroperitoneum, etc
- In additon these tumors must also be
- T1 or T2
- If a (≤5cm) then also N1
- If b (>5cm) then any nodal status (N0/1/x)
- M0
Stage 4:
- All sites
- These tumors are M1 (distant metastases) with either T1 or 2, a or b and any nodal status (N0/1/x)
TNM Staging Summary
| Stage 1 | Orbit, Head and neck (excluding parameningeal) GU – non-bladder/non-prostate Biliary Tract T1 or T2 (a or b) N0 or N1 or Nx M0 |
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| Stage 2 | Bladder/Prostate Extremity, Cranial Parameningeal, Other (includes trunk, retroperitoneum, etc.) Except Biliary tract T1 or T2 a N0 or Nx M0 |
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| Stage 3 | Bladder/Prostate T1 or T2 a N1 M0 Extremity Cranial Parameningeal, Other(includes trunk,retroperitoneum, etc.) Except Biliary tract T1 or T2b N0 or N1 or Nx M0 |
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| Stage 4 | All sites T1 or T2 a or b N0 or N1 M1 |
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