Cancer Staging
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My trick is to stage every patient in tumor board myself, and jot down the full T staging for that site while listening.
There are no tricks or mnemonics after medical school. You should just learn the staging.
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My favorite ENT mnemonic: "7 up, coke down." Refers to the orientation of the nerves in the distal IAC. (given to NPB this is arguably a gross anatomy or ENT sub I level of knowledge)
There are no cancer staging mnemonics that I know of. The good news is that most of the staging systems are similar, and once you understand the anatomy and how the disease behaves, it makes sense why they are how they are. I had melanoma on my oral boards, which is probably the hardest for me to remember, partly because I rarely see it.
Patterns... There are a lot of 2 and 4 cm cut offs for the T stage, hopefully you noticed that for most of the upper aerodigestive SCC. Learn the subsites of the larynx to learn supraglottic staging.
N stage is the same for a lot of primaries. Thyroid is a good exception to make sure you know the alternate N staging.
Then it is just a matter of recognizing the different primaries that have their own unique staging systems . Ehtesioneuroblastoma (Kadish staging system), ear canal & temporal bone (Arriaga modified Pittsburgh staging system), glomus tumors (multiple staging systems), nasopahryngeal ca, sinonasal ca. Even if you don't memorize them all, if you know they exist, you can quickly reference them.
There are no cancer staging mnemonics that I know of. The good news is that most of the staging systems are similar, and once you understand the anatomy and how the disease behaves, it makes sense why they are how they are. I had melanoma on my oral boards, which is probably the hardest for me to remember, partly because I rarely see it.
Patterns... There are a lot of 2 and 4 cm cut offs for the T stage, hopefully you noticed that for most of the upper aerodigestive SCC. Learn the subsites of the larynx to learn supraglottic staging.
N stage is the same for a lot of primaries. Thyroid is a good exception to make sure you know the alternate N staging.
Then it is just a matter of recognizing the different primaries that have their own unique staging systems . Ehtesioneuroblastoma (Kadish staging system), ear canal & temporal bone (Arriaga modified Pittsburgh staging system), glomus tumors (multiple staging systems), nasopahryngeal ca, sinonasal ca. Even if you don't memorize them all, if you know they exist, you can quickly reference them.
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I'd recommend you stage all new cancer pts when you see them. It forces you to review the criteria, sometimes a few times in the same day. Review it with your head and neck attending and see if you're on the same page. If not, they can explain to you what they saw differently.
Also, review the staging system prior to OR endoscopy. It gives you some idea of what size or locations you're looking for during the laryngoscopy. Plus it forces you to review it another time.
My only other tidbit in terms of head and neck cancer is to attend tumor board as much as possible. We had to go every week, no matter which rotation we were on. Works when you only work at one facility. Anyway, mentally stage the pt and consider what you'd recommend for them. Then listen and see what the group consensus is and why. Don't hesitate to ask a question. If they can tell you've put thought into the pt and want to learn about their treatment, they should be happy to clarify why your ideas may not be correct.
Also, review the staging system prior to OR endoscopy. It gives you some idea of what size or locations you're looking for during the laryngoscopy. Plus it forces you to review it another time.
My only other tidbit in terms of head and neck cancer is to attend tumor board as much as possible. We had to go every week, no matter which rotation we were on. Works when you only work at one facility. Anyway, mentally stage the pt and consider what you'd recommend for them. Then listen and see what the group consensus is and why. Don't hesitate to ask a question. If they can tell you've put thought into the pt and want to learn about their treatment, they should be happy to clarify why your ideas may not be correct.
I used one of the blank pages in the front of my Pasha book to write down all the T staging criteria for the various HNSCC subsites. It made for a handy review sheet until I got them all memorized.
I would start out by learning the N staging as it's the same for the vast majority of HNSCC.
For T staging, you just have to pound it into your head, though there are a few common patterns:
-<2 cm, 2-4 cm, >4 cm for T1, T2, T3 oral/oropharyngeal
-Any invasion into bone or surrounding structures is usually a T4
-For larynx/hypopharynx- VC hypomobility is T2, VC fixation is T3
I would start out by learning the N staging as it's the same for the vast majority of HNSCC.
For T staging, you just have to pound it into your head, though there are a few common patterns:
-<2 cm, 2-4 cm, >4 cm for T1, T2, T3 oral/oropharyngeal
-Any invasion into bone or surrounding structures is usually a T4
-For larynx/hypopharynx- VC hypomobility is T2, VC fixation is T3
Wow, that's big.
I always found this helpful not with T,N,M staging, but with overall staging. It applies to most squamous cell cancers of the upper aerodigestive tract, and with slight modification can be used for other types of cancers as well. It is obviously not a mnemonic, but it is easy to remember and easy to jot down at the start of your inservice so that you don't have to think about it during the actual exam. Keep in mind that T4bNxM0 cancers are still stage IVb, and and M is IVc.
I found that if I altered it to fit other cancer types (like thyroid cancers), it was still easy to remember once I had memorized this figure. For the TNM staging, unfortunately, I don't know of a great way to remember them other than repetition and memorization. But there is enough similarity that once you have your base down (oropharyngeal cancers), most of them are easy (save for things like sinonasal, cutaneous malignancies.)
Download the NCCN app for your phone. It'll help.
