Orthopaedic oncology Generic structured oral examination question 3: Staging

EXAMINER: So what stage is this tumour?

CANDIDATE: I would stage this tumour using the Musculoskeletal Tumour Society staging system as described

Table 7.1 Enneking/MSTS staging system.²

by Enneking.¹ We have discussed that it is a high-grade osteosarcoma, which makes it at least Stage II. It’s an intramedullary tumour that has invaded the surrounding soft- tissues making it extracompartmental, and upstaging it to IIB. We’ve not discussed whether there is any evidence of metastasis yet, but, if there is, that would immediately make it a Stage III, regardless of the other features we’ve talked about.

General advice: This question will usually follow a discussion about a malignant tumour, for example osteosarcoma as in this example. The Enneking system (Table 7.1) is the easiest to remember and can be applied equally to bony and soft-tissue sarco- mas.² The other commonly used system is the Ameri- can Joint Committee on Cancer (AJCC) system, which is more complicated. The AJCC also have separate systems for bony and soft-tissue tumours.

1. Enneking WF, Spanier SS, Goodman MA. Current concepts review. The surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am 1980;62-A:1027–1030.

2. NCCN. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma. V.2.2008. National Comprehensive Cancer Network, 2008.

Orthopaedic

Orthopaedic oncology Generic structured oral examination question 3: Staging

EXAMINER: So what stage is this tumour?

CANDIDATE: I would stage this tumour using the Musculoskeletal Tumour Society staging system as described

Table 7.1 Enneking/MSTS staging system.²

by Enneking.¹ We have discussed that it is a high-grade osteosarcoma, which makes it at least Stage II. It’s an intramedullary tumour that has invaded the surrounding soft- tissues making it extracompartmental, and upstaging it to IIB. We’ve not discussed whether there is any evidence of metastasis yet, but, if there is, that would immediately make it a Stage III, regardless of the other features we’ve talked about.

General advice: This question will usually follow a discussion about a malignant tumour, for example osteosarcoma as in this example. The Enneking system (Table 7.1) is the easiest to remember and can be applied equally to bony and soft-tissue sarco- mas.² The other commonly used system is the Ameri- can Joint Committee on Cancer (AJCC) system, which is more complicated. The AJCC also have separate systems for bony and soft-tissue tumours.

1. Enneking WF, Spanier SS, Goodman MA. Current concepts review. The surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am 1980;62-A:1027–1030.

2. NCCN. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma. V.2.2008. National Comprehensive Cancer Network, 2008.