V.5 Stage at Diagnosis

The stage to which the cancer has progressed at the time of diagnosis.

Stage provides a measure of disease progression, detailing the degree to which the cancer has advanced. Two methods commonly used to determine stage are AJCC and SEER historic. The AJCC method (see Collaborative Stage Data Collection System) is more commonly used in the clinical settings, while SEER has standardized and simplified staging to ensure consistent definitions over time.

SEER describes cancers in five stages:

• In situ cancer is early cancer that is present only in the layer of cells in which it began.
• Localized cancer is cancer that is limited to the organ in which it began, without evidence of spread.
• Regional cancer is cancer that has spread beyond the original (primary) site to nearby lymph nodes or organs and tissues.
• Distant cancer is cancer that has spread from the primary site to distant organs or distant lymph nodes.
• Unstaged cancer is cancer for which there is not enough information to indicate a stage

Stage at Diagnosis is a grouping of cases into broad categories, for example, localized, regional, and distant. This is different than Extent of Disease which is a detailed description of the spread of the disease from the site of origin.  

January 1, 2004 and Forward

Beginning with cases diagnosed January 1, 2004 and forward, the CCR requires the collection of Collaborative Staging (CS) data items necessary to derive AJCC T, N, M, Stage Group, Summary Stage 1977, and Summary Stage 2000.

Prior to January 1, 2004

For cases seen prior to January 1, 2004, apply the following guidelines:

In the Stage at Diagnosis field, enter the code that represents the farthest tumor involvement as indicated by all the evidence obtained from diagnostic and therapeutic procedures performed during the first course of treatment or within four months after the date of diagnosis, whichever is earlier. (See Section VI.1 for definitions of first course of treatment and definitive treatment.) Coding must be supported by textual information entered under Diagnostic Procedures (see Section IV.1).

Stage at Diagnosis is not required beginning with cases diagnosed January 1, 1994. Hospitals wishing to do so may continue its use.

Prior to January 1, 1994

Cases diagnosed prior to January 1, 1994 must continue to be staged using SEER Summary Staging Guide 1977. This document is available from SEER.

Rules for Summary State 1978 and SEER Summary Stage 2000

Although Summary Stage is not required by the CCR, it is required by NAACCR and NPCR. The rules for using SEER Summary Stage 1977 and SEER Summary Stage 2000 are as follows:

Cancer cases diagnosed before January 1, 2001 should be assigned a summary stage according to SEER Summary Stage Guide 1977.

Cases diagnosed on or after January 1, 2001 should be assigned a stage according to SEER Summary Stage 2000.

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