ABCD rating system
The ABCD rating system refers to two distinct frameworks used for assessing different types of cancer, specifically prostate cancer and melanoma. Initially, the system classified stages of prostate cancer into four categories: Stage A represented very small, localized tumors; Stage B involved larger tumors still confined to the prostate; Stage C indicated regional spread beyond the prostate; and Stage D identified metastatic disease that had spread to other parts of the body. Although the ABCD system was utilized until 1997, it has since been replaced by the tumor, nodes, and metastasis (TMN) system, which provides a more detailed classification for prostate cancer treatment planning.
In addition to prostate cancer, the ABCD system has a parallel application in melanoma detection, which was later expanded to include an "E" for evolving characteristics of skin lesions. The ABCDE rule for melanoma focuses on key warning signs, such as asymmetry, border irregularity, color variation, diameter, and changes over time, aiding in the early detection of this serious skin cancer. The adoption of these rating systems has enhanced cancer detection and treatment strategies, emphasizing the importance of awareness and regular self-examinations for individuals at risk.
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ABCD rating system
ALSO KNOWN AS: Jewett staging system or the Whitmore-Jewett staging system (for prostate cancer)
DEFINITION: There are two distinct ABCD rating systems for cancer. The first used the symbols A, B, C, and D to define the stages of prostate cancer. The second uses these designations and a fifth criterion of E for evolving to describe the early warning signs of melanoma, the most serious type of skin cancer.
Cancers monitored:Prostate cancer and melanoma (each with its own distinct alphabetical rating)
Why performed: After detecting prostate cancer, the physician will evaluate the stage of the tumor according to its size, its location, and the extent to which it may have spread to other parts of the body. This information is important for choosing the best treatment plan. Staging of prostate cancer is based on the findings of clinical tests, mainly a digital rectal examination, a test to measure the level of prostate-specific antigen (PSA) in the blood, and transrectal ultrasonography. Other tests may include computed tomography (CT) scans, magnetic resonance imaging (MRI), and bone scans to assess the spread of the disease.
From 1975 to 1997, the ABCD rating system, or the Jewett staging system, was used to classify the stages of prostate cancer. In 1997, the tumor, nodes, and metastasis (TMN) system was adopted as the predominant prostate cancer staging system. The TMN system expanded upon the earlier four-stage categorization with additional subcategories to describe tumor development more precisely. The TMN system takes into account the size of the tumor, its expansion into the lymph nodes, further metastasis, and the cancer grade.
For melanoma prevention, the American Cancer Society (ACS) recommends monthly skin self-examinations. The ABCDE guideline for melanoma serves as a reference when looking for any suspicious changes in the appearance of spots or sores that do not heal. Usually, this means monitoring any variation in the size, shape, growth, or color of a new or existing mole. Any suspicious mole should be checked by a physician, who may decide to resect an abnormal-looking lesion and send the tissue for pathological review.
Results: The ABCD rating for prostate cancer was used to classify the disease into four basic stages.
- Stage A: Localized disease in which the cancer was very small, confined to the prostate gland, not palpable during a rectal examination, and identified by high PSA levels and biopsy.
- Stage B: Localized disease in which the cancer was larger and confined to the prostate gland, but a lump was palpable during a rectal examination.
- Stage C: Regional disease in which the cancer had grown through the prostate capsule and into surrounding tissues, perhaps into the seminal vesicles. Still, the cancer had not spread to other areas of the body.
- Stage D: Metastatic disease in which the cancer had grown into the pelvic area or had spread to the lymph nodes, bones, or other parts of the body.
The ABCDE rule for melanoma detection lists the five usual warning signs of the disease for most types of melanomas.
- A (asymmetry): The two halves of the skin lesion are dissimilar.
- B (border irregularity): The lesion has ragged or poorly defined edges.
- C (color): The color of the lesion is uneven, with different shades of brown or black.
- D (diameter): The lesion is usually greater than five millimeters or one-quarter inch.
- E (evolving): The shape, size, or color of the lesion has changed over time.
While the ABCD rating system is no longer in use for prostate cancer, it allowed for the development of the TMN system, which has helped streamline efficient and effective prostate cancer treatment. In the twenty-first century, the ABCDE rule for melanoma detection has significantly contributed to the early diagnosis of skin cancers. A public awareness campaign surrounding the system led to increased attention to the importance of at-home skin checks.
Bibliography
“Melanoma Skin Cancer - Understanding Melanoma.” American Cancer Society, www.cancer.org/cancer/types/melanoma-skin-cancer.html. Accessed 9 June 2024.
"Prostate Cancer Information and Overview." American Cancer Society, www.cancer.org/cancer/types/prostate-cancer.html. Accessed 9 June 2024.
“Prostate Cancer Staging.” MedlinePlus, 1 July 2023, medlineplus.gov/ency/patientinstructions/000397.htm. Accessed 9 June 2024.
“Prostate Cancer Treatment (PDQ®) - NCI.” National Cancer Institute, 11 Mar. 2024, www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Accessed 9 June 2024.
Pietrangelo, Ann. “What is the ABCDE Rule for Detecting Skin Cancer?” Healthline, 10 Feb. 2022, www.healthline.com/health/skin-cancer/abcd-rule-for-skin-cancer. Accessed 9 June 2024.
Silva, Juliana Hypólito, Bianca Costa Soares de Sá, Alexandre Leon Ribeiro de Ávila, Gilles Landmen, and João Pedreira Duprat Neto. "Atypical Mole Syndrome And Dysplastic Nevi: Identification of Populations At Risk for Developing Melanoma—Review Article." Clinics, vol. 66.3, 2011, pp. 493–99.