Computer program created by Dr Sanjoy Sanyal, Professor and Course Director of Neuroscience in the Caribbean. Paper was presented at Stanford Medicine X Conference in September 2012, Stanford University School of Medicine, CA. Patent Pending with USPTO January 2013. Cancer e-Staging Standalone Program• A multi-step process was used to create the e- Staging Program.• It has 5 electronic pages, requiring 4 mouse clicks• Content page of the e-Staging tool gives a list of 26 cancers.• Once on any Tumor page, the physician is asked to successively select the appropriate T, N, M status of that cancer.• It takes the physician seamlessly through the 3 steps.• Final page gives cancer Stage.

1. An Excel™-based e-Staging Tool for Tumors
Dr. Sanjoy Sanyal MBBS, MS (Surgery), MSc (Royal College of Surgeons, Edinburgh),
ADPHA
Professor and Course Director, Medical University of the Americas, West Indies
Abstract
Given the extreme complexity of grouping the T, N, M status of a tumor into its Stages, it is
impossible to determine the Anatomical Stage Grouping of any tumor without the aid of complex
TNM charts created by UICC. In order to render the process time- and user-friendly for the
physician, an Excel-based e-Staging tool was created for 26 tumors of the human body. With just 4
mouse clicks one can arrive at the Stage of the tumor. This is a standalone tool, not requiring Internet
connection, and can be used in a handheld device in any hospital or clinic.
Introduction
In the Union for International Cancer Control (UICC) TNM classification, Tumor status (T) is
designated as T1, T2 etc, regional lymph Node metastases (N) are designated as N0, N1 etc, and
distant Metastases (M) are designated as M0, M1. For some tumors, like Seminoma of testis, Serum
tumor marker (S) is an additional parameter. Each parameter may be further subdivided into 'a', 'b'
etc. The three (or four) major parameters are grouped in increasing stages of cancer to give the
Anatomical Stage Grouping of the tumor, designated by Roman numeral I, II etc. For many tumors
the Stages may be subdivided into 'A', 'B'.
Materials & Methods
Step 1: Tabulating ‘T’, ‘N’, ‘M’ (and any other) categories and Stages of Tumor on a plain paper,
with data from UICC 7th Edition website
Step 2: Employing mathematical rules of Permutations and Combinations, determining all possible
combinations of TN, TNM, TNMS (if applicable) for that tumor
Step 3: Designating each combination to an Excel worksheet, with appropriate Worksheet name
Step 4: Designating all stages of the tumor to separate Excel sheets
Step 5: Book-marking and Hyper-linking the T sheet with TN sheets, then to TNM sheets and finally
to each tumor Stage sheet in the file
Step 6: Repeating the process for 26 tumors of the human body on the same Excel Workbook
Step 7: Hyper-linking each tumor Worksheet to a Contents page on the same Excel Workbook (file)
Step 8: Inserting illustrations and converting the file into .mht format
Results
Content page of the e-Staging tool gives a list of 26 tumors. Once on any Tumor page, the physician
is asked to successively select the appropriate T, N, M status of that tumor. It takes the physician
seamlessly through the 3 steps. Final page gives tumor Stage.
Content page: 1st click

2. T page: 2nd click
N page: 3rd click
M page: 4th click

3. Stage page: Final
Discussion
The permutations and combinations of T, N, M (and S) within a particular Anatomical Stage
Grouping is extremely complex and varies considerably between different tumors. This complex
classification renders it difficult for the oncologist to quickly determine the Stage of tumor without
the aid of a TNM chart.
This interactive e-Staging tool is standalone (in .mht format), simpler (requiring only 4 mouse
clicks), quicker (just a few seconds) and easier than those from Stage CRAFT©, AJCC and
Melanoma Center, which are all Web-based. It can be used by any physician with minimum
computer skills. It is portable, can be used in any hand-held device anywhere in the hospital or clinic,
and does not require Internet connection. It eliminates consulting complicated TNM charts, which
are different for every tumor, and also the need to rely on memory, thus reducing errors and
inconsistency between physicians. The tool can be incorporated in a hospital EMR with HL7. It is
future-scalable, with options to add more tumor sites to the system.
Acknowledgements
Assistance of Medical University of the Americas in preparing the poster is gratefully acknowledged.
Authorship and Conference Presentation
This paper was authored by Dr Sanjoy Sanyal, Professor and Course Director of Neuroscience in
Medical University of the Americas, Potworks, Charlestown, Nevis, St.Kitts-Nevis, West Indies. It
was accepted at the international Stanford Medicine X Conference, and presented as a poster in

4. Stanford University School of Medicine, LKSC Conference Center, 291 Campus Drive, Stanford,
California, CA 94305-5101, USA, on 30 September, 2012.
Poster Screenshot
CANCER E-STAGING STANDALONE PROGRAM
Process Flowchart for Implementation of Program

5. Implementation Step 1
Implementation Step 2

6. Implementation Step 3
Implementation Step 4

7. Implementation Step 5
PATENT STATUS
Provisional Patent Application accepted by United States Patent and Trademark Office (USPTO),
giving it a 'Patent Pending' status.