With the increasing trend toward combined therapies in clinical, oncologic, investigational protocols, there is a demand for greater accuracy in staging the true extent of the cancer at the initiation of treatment. The development of a clinical form of staging is often passed over in favor of the greater accuracy of surgical evaluation. The surgical evaluation is coupled with pathological examination, further refining the accuracy of anatomic staging. However, with the application of preoperative adjuvants such as irradiation therapy and chemical agents, an alteration of staging occurs and renders surgical staging meaningless unless it is compared to a pretreatment evaluation.
The obstacles to an acceptable clinical staging relate to a few key points. First, a classification must be precise, simple, and meaningful so that it can be applied generally in practice and reporting. Second, the diagnostic procedures which are used in arriving at a clinical staging must be defined and