· Stages and Grades of Cancer: The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. Cancers can be staged in various methods such as Ann Arbor staging, TNM staging, Roman Numeral Staging.

· In transcription, the word “stage” and “grade” of cancer are not capitalized.

· By rule with stage, Roman numerals are used, and with grade, Arabic numerals are used.

· If the stage has a subdivision, it is placed immediately after the roman numeral without space. Subdivisions contain uppercased alphabet or Roman numerals only. For example:

stage I grade 1
stage IIA grade 4
stage III3
stage IVB

Several classification systems have been developed depending upon the body areas affected and the extent of tumor. These are as follows:

Roman Numeral Staging
This system uses numerals I, II, III, and IV to describe the progression of cancer.
· Stage I cancers are localized to one part of the body.
· Stage II cancers are locally advanced, as are Stage III cancers. Whether a cancer is designated as Stage II or Stage III can depend on the specific type of cancer; for example, in Hodgkin's Disease, Stage II indicates affected lymph nodes on only one side of the diaphragm, whereas Stage III indicates affected lymph nodes above and below the diaphragm. The specific criteria for Stages II and III therefore differ according to diagnosis.
· Stage IV cancers have often metastasized, or spread to other organs or throughout the body.

TNM staging
TNM Staging is used for solid tumors, and is an acronym for the words Tumor, Nodes, and Metastases. Each of these criteria is separately listed and paired with a number to indicate the TNM stage. A T1N2M0 cancer would be a cancer with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body).

· T (TI-T4): Tumor (T) refers to the primary tumor and carries a number of 0 to 4.
· N (N1-N3): N represents regional lymph node involvement and can also be ranked from 0 to 4.
· M (M0-Ml): Metastasis is represented by the letter M, and is 0 if no metastasis has occurred or 1 if metastases are present.

For example:
T2, N1, M0
TX, N0, M0

· TNM classification makes use of staging indicators to define cancer and assess their stage. Capital letters are used for staging followed by Arabic numeral without space. These are:
Grade: GX, G 1, G2, G3
Host performance: HO, HI, H2, H3, H4
Lymphatic invasion: LX, La, L1, L2
Residual tumor: RX, RO, RI, R2
Scleral invasion: SO, Sl, S2
Venous invasion: VX, VA, VI, V2

Broders Index
Broders index is a classification used to report the aggressiveness of a malignant tumor. It is reported in grades from 1 to 4, with grade 1 having best prognosis and grade 4 the worst. Arabic numeral from 1 to 4 is used to specify the grade with grade being in lower case.
For example: Broders grade 4.

CIN System
CIN stands for cervical intraepithelial neoplasia and is used to classify the lesions of the cervical cancer. It is classified from 1 to 3 Arabic numerals, where
· 1 represents mild dysplasia (lower severity),
· 2 represents moderate dysplasia, and
· 3 represents severe dysplasia (maximum severity). To transcribe, place the grade specified online with CIN with a hyphen joining the two.

For example: ClN-1

Clark Level
This classification is used to report level of invasion of the primary malignant melanoma or the skin, arising from epidermis. Roman numeral from I to V are used to indicate the invasion.

Clark level I limited to epidermis.
Clark level II into underlying papillary dermis.
Clark level III to junction of papillary and reticular dermis.
Clark level IV into reticular dermis
Clark level V into subcutaneous fat.

Dukes Classification
This classification is used to report the extent of operable adenocarcinoma of the colon or rectum. It is classified from A to C (uppercase alphabets).

Dukes A confined to mucosa.
Dukes B1: extends into muscularis mucosa.
Dukes B2: extends through the muscularis mucosa.

Dukes C1: limited to the bowel wall with metastasis to the lymph nodes.
Dukes C2: extends through the bowel wall with metastasis to the lymph nodes.

Dukes is transcribed without apostrophe, (Dukes) and not (Duke's), with alphabet A, B, or C on the same line. The Arabic numerals for subdivision of Band C are transcribed just immediate after it without the space.
For example: Dukes C1

FAB Classification
It is a system of classification for acute leukemias, lymphocytic and myelogenous, where FAB stands for French-American-British. This system utilizes FAB classification of malignant tumors explained later in this section.

Acute lymphocytic leukemia is divided in three classes, and transcribed by placing capital letter followed by Arabic numeral 1 through 3.

· Small lymphoblasts with mature appearance
· More immature than L1, with different nuclear shapes and sizes
· Relatively large lymphoblasts

Acute myelogenous leukemia is classified from 0 to 7 (Arabic numerals). Upper case M is to precede the numeral without a space.

M0: undifferentiated
M1: myeloblastic, with some immature cells
M2: myeloblastic with differentiation of cells
M3: promyelocytic
M4: myelomonocytic
M5: monocytic
M6: erythroleukemia
M7: megakaryocytic

FIGO Staging
It is a system of classification for staging of gynecologic cancers. FIGO stands for Federation Internationale de Gynecologie et Obstetrique on the organization, which developed it. It is expressed in stages 0 to IV with 0 being precancerous stage, and IV being highly malignant and most severe. For subdivisions, upper case alphabets are used without space from the division. For example: ovarian cancer, FIGO stage IIB.

Gleason Tumor Score
It is a classification system used for adenocarcinoma of the prostate gland. The score or grade to determine the severity is reached at by totaling the score achieved on a scale of 1 to 5 for each dominant and secondary pattern. The higher the score, the severer is the prognosis. Arabic numeral is used for the score with space between word grade and score. For example: The patient has Gleason score 8.

Jewett and Strong Staging
It is a system used to classify extent of the bladder carcinoma, from class 0 to 0 depending upon the extent of invasion. Uppercased alphabets are used.

O: non-invasive, in situ
A: invading submucosa
B: invading mucosa
C: invading surrounding tissue
D: lymph node metastasis

For example: The patient has bladder carcinoma, Jewett Class C.

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