Medulloblastoma staging: Difference between revisions

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__NOTOC__
__NOTOC__
{{Medulloblastoma}}
{{Medulloblastoma}}
{{CMG}} {{AE}}{{HL}}
{{CMG}} {{AE}}{{sali}}{{HL}}


==Overview==
==Overview==
The staging of medulloblastoma is based on the modified Chang's staging system. Medulloblastoma patients are risk stratified into either a standard risk group or a high risk group based on the [[tumor]] stage, the patient's age, and the extent of any previous surgical resection.<ref name="pmid597384">{{cite journal| author=Harisiadis L, Chang CH| title=Medulloblastoma in children: a correlation between staging and results of treatment. | journal=Int J Radiat Oncol Biol Phys | year= 1977 | volume= 2 | issue= 9-10 | pages= 833-41 | pmid=597384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=597384  }} </ref><ref name="b">Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 282015)</ref>
==Modified Chang's Staging of Medulloblastoma==
The staging of medulloblastoma is based on the modified Chang staging system.<ref name="pmid597384">{{cite journal| author=Harisiadis L, Chang CH| title=Medulloblastoma in children: a correlation between staging and results of treatment. | journal=Int J Radiat Oncol Biol Phys | year= 1977 | volume= 2 | issue= 9-10 | pages= 833-41 | pmid=597384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=597384  }} </ref>


__NOTOC__
==TNM Classification of Medulloblastoma==
===T: Primary Tumor===
===T: Primary Tumor===


{| style="cellpadding=0; cellspacing= 0; width: 800px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description'''
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |TX || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Primary tumor cannot be assessed
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''TX''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Primary [[tumor]] cannot be assessed


|-
|-


|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | T0 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |There is no evidence of primary tumor
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''T0''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |There is no evidence of primary tumor


|-
|-


|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size <3 cm in diameter
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''T1''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size <3 cm in diameter


|-
|-


|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size ≥3 cm in diameter with no evidence of extension
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''T2''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size ≥3 cm in diameter with no evidence of extension


|-
|-


|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3a ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size >3 cm in diameter with extension into aqueduct of Sylvius or foramen of Luschka
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''T3a''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size >3 cm in diameter with extension into [[aqueduct of Sylvius]] or foramen of [[Luschka]]


|-
|-


|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3b ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size >3 cm in diameter with definite spread into the brain stem
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''T3b''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Tumor size >3 cm in diameter with definite spread into the [[brain stem]]


|-
|-


|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T4 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | Tumor size >3 cm in diameter with extension past aqueduct of Sylvius or down past foramen magnum
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''T4''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | Tumor size >3 cm in diameter with extension past aqueduct of Sylvius or down past [[foramen magnum]]
|}
|}


===N:Regional Lymph Nodes===
===M: Distant Metastasis===
*An N classification cannot be applied to medulloblastoma.
 
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''M'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description'''
|-
 
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''M0'''||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |No evidence of metastasis
|-
 
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''M1''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | Microscopic tumor cells present in the [[cerebrospinal fluid]]
 
|-
 
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''M2''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |Gross [[nodular]] seeding present intracranially beyond the primary tumor site


===M: Distant Metastasis===
|-
 
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''M3''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | Gross nodular seeding present in the spinal [[subarachnoid space]]
 
|-
 
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''M4''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | Metastasis present outside the cerebrospinal axis
|}
 
==Risk Stratification==
* Medulloblastoma patients are risk stratified into either a standard risk group or a high risk group based on the [[tumor]] stage, the patient's age, and the extent of any previous surgical resection.<ref name="pmid23245832">{{cite journal| author=Bartlett F, Kortmann R, Saran F| title=Medulloblastoma. | journal=Clin Oncol (R Coll Radiol) | year= 2013 | volume= 25 | issue= 1 | pages= 36-45 | pmid=23245832 | doi=10.1016/j.clon.2012.09.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245832  }} </ref>
* Risk stratification determines the protocol of management used for medulloblastoma patients.
* The table below demonstrates the risk stratification for medulloblastoma patients:<ref name="pmid23245832">{{cite journal| author=Bartlett F, Kortmann R, Saran F| title=Medulloblastoma. | journal=Clin Oncol (R Coll Radiol) | year= 2013 | volume= 25 | issue= 1 | pages= 36-45 | pmid=23245832 | doi=10.1016/j.clon.2012.09.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245832  }} </ref><ref name="b">Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 282015)</ref>


==Classification of Medulloblastoma by Staging==
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px"
|valign=top|
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|'''Parameters'''}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|'''Standard Risk Group'''}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|'''High Risk Group'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Age'''
| style="padding: 5px 5px; background: #F5F5F5;"|
:::::Patients older than 3 years of age
| style="padding: 5px 5px; background: #F5F5F5;" |
:::::Patients younger than 3 years of age
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
'''Extent of previous surgical resection'''
| style="padding: 5px 5px; background: #F5F5F5;" |
::::<1.5 cm² residual tumor after resection
| style="padding: 5px 5px; background: #F5F5F5;" |
::Subtotal resection '''or''' >1.5 cm² residual tumor after resection
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
'''Tumor stage'''
| style="padding: 5px 5px; background: #F5F5F5;" |
:::M0 stage confirmed by [[MRI]] and [[CSF]] sampling
| style="padding: 5px 5px; background: #F5F5F5;" |
:::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding
|}


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Neurology]]
[[Category:Neurosurgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Neurosurgery]]
[[Category:Neurosurgery]]

Latest revision as of 14:44, 2 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]Haytham Allaham, M.D. [3]

Overview

The staging of medulloblastoma is based on the modified Chang's staging system. Medulloblastoma patients are risk stratified into either a standard risk group or a high risk group based on the tumor stage, the patient's age, and the extent of any previous surgical resection.[1][2]

Modified Chang's Staging of Medulloblastoma

The staging of medulloblastoma is based on the modified Chang staging system.[1]

T: Primary Tumor

T Description
TX Primary tumor cannot be assessed
T0 There is no evidence of primary tumor
T1 Tumor size <3 cm in diameter
T2 Tumor size ≥3 cm in diameter with no evidence of extension
T3a Tumor size >3 cm in diameter with extension into aqueduct of Sylvius or foramen of Luschka
T3b Tumor size >3 cm in diameter with definite spread into the brain stem
T4 Tumor size >3 cm in diameter with extension past aqueduct of Sylvius or down past foramen magnum

M: Distant Metastasis

M Description
M0 No evidence of metastasis
M1 Microscopic tumor cells present in the cerebrospinal fluid
M2 Gross nodular seeding present intracranially beyond the primary tumor site
M3 Gross nodular seeding present in the spinal subarachnoid space
M4 Metastasis present outside the cerebrospinal axis

Risk Stratification

  • Medulloblastoma patients are risk stratified into either a standard risk group or a high risk group based on the tumor stage, the patient's age, and the extent of any previous surgical resection.[3]
  • Risk stratification determines the protocol of management used for medulloblastoma patients.
  • The table below demonstrates the risk stratification for medulloblastoma patients:[3][2]
Parameters Standard Risk Group High Risk Group

Age

Patients older than 3 years of age
Patients younger than 3 years of age

Extent of previous surgical resection

<1.5 cm² residual tumor after resection
Subtotal resection or >1.5 cm² residual tumor after resection

Tumor stage

M0 stage confirmed by MRI and CSF sampling
M1-M3 stage or presence of leptomeningeal seeding

References

  1. ↑ 1.0 1.1 Harisiadis L, Chang CH (1977). "Medulloblastoma in children: a correlation between staging and results of treatment". Int J Radiat Oncol Biol Phys. 2 (9–10): 833–41. PMID 597384.
  2. ↑ 2.0 2.1 Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 282015)
  3. ↑ 3.0 3.1 Bartlett F, Kortmann R, Saran F (2013). "Medulloblastoma". Clin Oncol (R Coll Radiol). 25 (1): 36–45. doi:10.1016/j.clon.2012.09.008. PMID 23245832.
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