Staging of Malignant Tumours - Callum Clark 16/5/2002

Important for:


Planning treatment


Musculoskeletal Tumour Society Surgical Staging System (1980) / Enneking System

2 systems:



Surgical Grade (=clinical factors+histology)

G1 = Low grade (potential for mets < 25%)

G2 = High grade (potential for mets > 25%)

Surgical Site:

T1 = intracompartmental

T2 = extracompartmental

Metastases (or regional lymphatic spread)

M0 = none

M1 = mets

GTM used to create six stages:

1a G1 T1 M0

1b G1 T2 M0

2a G2 T1 M0

2b G2 T2 M0

3a G1or2 T1 M1

3b G1or2 T2 M1

The Staging Process

(Biopsy = last if clinically aggressive tumour)

1/ History/Examination-

5 primary sites + liver mets

2/ Radiology:

Radiographs in 2 planes —

"Enneking's 4 questions"

Abdo Ultrasound

Bone Scan —

Monostotic vs Polyostotic

1.6% of malig. Bone tumours metastasise to bone

Multiple Myeloma


Anatomic site and extent (including soft tissue)


Cannot delineate between benign and low-grade malignant


Tumour extent

Planning arterial chemotherapy


Planning limb salvage


3/ Laboratory studies:

Bloods- FBC, ESR, Bone, LFT, Acid Phos, PSA, TFT, serum electrophoresis

Urine- Bence Jones Proteins

4/ Biopsy:

Should be performed by the surgeon who will perform the tumour resection

(Musculoskeletal Tumour Society)

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