Your guide to the Enneking system which helps your surgeon decide about treatment for cancer that starts in your bone (primary bone cancer). A System for the Surgical Staging of. Musculoskeletal Sarcoma. WILLIAM. F. ENNEKING,. M.D.,* SUZANNE. S. SPANIER,. M.D.,** AND. MARK A. GOODMAN, . Based on a combination of histologic grade (G), anatomic site (T), and presence or absence of distant metastasis (M) Grade G0 = benign G1 = low grade.

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Many factors are involved in choosing the proper therapy for the patients. Use of this system along with the Weinstein-Boriani-Biagini WBB classification has been studied for spinal tumors and appears to be safe and feasible and to improve disease control and survival, although both systems show only moderate interobserver reliability and additional studies are warranted [ 1 ]. L8 – 10 years in practice.

The Enneking surgical staging system has been used for classification of musculoskeletal tumors surgeons around the world. Ideally, a combination ennekjng the staging systems may provide a stronger instrument than either alone. There are different systems for staging bone cancer. Limitations The Enneking surgical staging system is based on the natural evolution of mesenchymal tumors and thus is not applicable to tumors originating in either the marrow or reticuloendothelial system.

Bone cancer Stages and grades. These tumors are characterized by low mitotic rates, low nuclear to cytoplasmic ratio, and limited pleomorphism. Prognosis for soft tissue tumors depends on grade low grade: Almost all the reported problems were related to assessing compartmental containment of tumor.

For spinal column tumors, the Enneking surgical staging system does not take into account the presence of a continuous epidural compartment, neurologic implication of sacrificing the spinal cords and roots, and need for restoring spinal stability. The cancer is either inside the bone or grown through the bone into nearby structures.

As defined by the International Union Against Cancer, the objectives of cancer staging are 1 to aid in rnneking the course of treatment, 2 to provide insight into the prognosis, 3 to assist in evaluating the results of treatment, 4 enneing facilitate effective interinstitutional communication, ennekinh 5 to contribute to continuing investigation of human malignancies [ 7 ].


Stage III represents any tumor with distant metastasis. Those responsive to chemotherapy may be treated successfully using wide excision and adjuvant therapy.

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This classification is based on radiographic characteristics of staginb tumor-host margin.

Bone Tumor Staging Systems

Author information Copyright and License information Disclaimer. The use of adjuvant therapies then is indicated to eradicate tumor cells that would remain after surgical resection. Viswanathan S, Jambhekar NA. High grade, are usually extracompartmental, and have a significant risk for skip metastases.

Radiologic and pathologic sfaging of solitary bone lesions. History Since its establishment inthe American Joint Committee for Cancer AJCC has undertaken the responsibility for developing clinically useful staging systems for various types of cancer. Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website.

Metastatic bone cancer has spread to other parts of the body farther from the original tumour.

Bone Tumor Staging Systems – Pathology – Orthobullets

The task force on malignant bone tumors of the AJCC could not stging on a satisfactory system and recommended institutions with access etaging large numbers of patients, consistency in management, and long-term followups undertake this task [ 2 ].

Neoplasms may be benign, pre-malignant or malignant. Enneking staging for benign musculoskeletal tumors based on radiographic characteristics of the tumor host margin. Please review our privacy policy. For benign tumors, local aggressiveness and incidence of recurrence etaging with increase in surgical grade. Doctors may use the simple staging system or the Enneking staging system. Stage 2A The cancer is high grade and is only inside the bone. Intramembranous bone is without physes and grows and then stops as controlled by genetic script.


Each lesion ultimately is assessed on histologic features; however, some tumors are high grade by definition, such as a dedifferentiated chondrosarcoma [ 3 ].

Enneking surgical staging system | Radiology Reference Article |

In the Enneking staging system, a Neoplasm Neoplasm is an abnormal mass of tissue as a result of neoplasia. The cancer is high grade and has grown though the bone enheking into other nearby structures. Each stage is further divided into two subcategories A, B based on the local extent of tumor.

The Enneking surgical staging system stagijg reliable, reproducible, and of prognostic importance for musculoskeletal sarcomas, especially for those originating in the axial skeleton. J Am Acad Orthop Surg.

Recurrent bone cancer means that the cancer has come back after it has been treated. Get more on Musculoskeletal Health in your inbox Subscribe to our Newsletter and get updates delivered to your email inbox.

The growth of this clone of cells exceeds, and is uncoordinated with, that of the normal tissues around it. Select the text below and copy the link. Metastases are rare for locally aggressive benign lesions but do rarely occur in giant cell tumor and chondroblastoma. M1 regional or distant. What is the likely diagnosis?

Enneking staging system

Open in a separate window. Ina system for surgical staging of musculoskeletal sarcoma was proposed, studied, and adopted by the Musculoskeletal Tumor Society and subsequently by the AJCC [ 4 ]. L7 – years in practice. Enneking staging for malignant musculoskeletal tumors based on surgical grade, local extent, and presence or absence of metastasis.

Thus a fracture varies from a hairline fracture where the fracture appears as a crack on x-ray to displaced fracture where the bone has broken in its entirety with fragments going far apart. It has not spread to other areas of bone or any other part of the body.