Synopsis
Distinguish anatomical stage, pathological grade and functional performance status, establish each with the correct evidence, and use them with biology and patient priorities rather than as interchangeable labels.
- Stage describes anatomical extent, usually primary tumour, regional nodes and distant metastasis; the applicable TNM edition and tumour-specific system must be named.
- Clinical stage uses examination, imaging and biopsy information before definitive surgery, while pathological stage incorporates resection findings and may be more precise.
- Grade describes microscopic differentiation, proliferation or tumour-specific biological aggressiveness and is not another word for stage.
- Performance status summarises functional impact and treatment tolerance but can be worsened by reversible infection, anaemia, obstruction, pain or dehydration.
- Staging tests should be selected because they change treatment intent, field or operation; indiscriminate imaging creates incidental findings and delay.
- A higher stage does not automatically mean no meaningful treatment, and a low stage does not guarantee favourable biology.
- Restaging after neoadjuvant treatment must distinguish baseline clinical extent from treatment-response findings and use the correct prefix conventions.
- Record evidence and uncertainty, not just a number, so future teams can reconstruct how the decision was made.
Investigation priorities
Define local, nodal and distant extent before treatment.
Management branches
Cancer is histologically confirmed or strongly suspected and definitive planning begins.
- Name the tumour subtype, staging system and edition, then identify which anatomical findings could change treatment intent.
- Complete the site-specific imaging and tissue pathway, confirming equivocal distant lesions when the consequence would be major.
- Assign clinical stage with the supporting evidence and preserve this baseline through any neoadjuvant treatment.