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Non-Rhabdomyosarcoma (Non-RMS)





Soft tissue sarcomas have different routes of spread:

  • Local
  • Lymphatic
    • Unusual in soft tissue sarcomas but can occur in:
      • Epithelioid sarcoma
      • Clear cell sarcoma
      • Malignant fibrous histiocytoma (pleomorphic sarcoma)
      • Ewing sarcoma (extra-osseous)
      • Synovial sarcoma
      • Alveolar soft part sarcoma
  • Distant
    • Generally to lungs, but rarely can spread to bone


The American Joint Committee on Cancer (AJCC) has a soft tissue sarcoma staging system to describe extent of disease and prognosis using four criteria:

  • Tumor size (T)
  • Nodal status (N)
  • Metastasis (M)
  • Grade (G)

In this system:

  • Superficial tumor located:
    • Above the superficial fascia without invasion of the fascia
  • Deep tumor located:
    • Beneath the superficial fascia
    • Superficial to the fascia with invasion of or through the fascia or
    • Both superficial yet beneath the fascia.


AJCC Primary Tumor Staging:

TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor less than or equal to 5 cm in greatest dimension
T1a Superficial tumor less than or equal to 5 cm in greatest dimension
T1b Deep tumor less than or equal to 5 cm in greatest dimension
T2 Tumor greater than 5 cm in greatest dimension
T2a Superficial tumor greater than 5 cm in greatest dimension
T2b Deep tumor greater than 5 cm in greatest dimension


AJCC Lymph Node Staging:

NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastases
N1 Regional lymph node metastases


AJCC Distant Metastases:

M0 No distant metastases
M1 Distant metastases


Grading (simplified)

  • Several grading systems have been published and correlate with prognosis
  • Two most important parameters appear to be mitotic index and extent of tumor necrosis.


Grade 1
  • Tumor closely resembles normal adult mesenchymal tissue
  • Low mitotic count
  • No necrosis
Grade 2
  • Sarcomas where histological typing is certain
  • Intermediate mitotic count
  • <50% tumor necrosis
Grade 3
  • Embryonal and undifferentiated sarcomas
  • Synovial sarcomas
  • Osteogenic sarcomas
  • High mitotic count
  • > or = 50% tumor necrosis


AJCC Anatomic Stage:

Stage 1A T1a N0 M0 G1, GX
T1b N0 M0 G1, GX
Stage 1B T2a N0 M0 G1, GX
T2b N0 M0 G1, GX
Stage IIA T1a N0 M0 G3, G3
T1b N0 M0 G3, G3
Stage IIB T2a N0 M0 G2
T2b N0 M0 G2
Stage III T2a, T2b N0 M0 G3
Any T N1 M0 Any G

Stage IV


Any T Any N M1 Any G


Link to Staging PDF





WHO classification of soft tissue sarcomas

Stage information for adult soft tissue sarcomas at the NCI




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