The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.
TNM is updated periodically based on advances in understanding of advances of cancer prognosis to remain current and relevant to clinical practice. The latest revision of TNM, presented in the 7th edition of the AJCC Cancer Staging Manual, takes effect for cases diagnosed on or after January 1, 2010.1 This supplants the 6th edition, in use since 2003. Beginning in this volume, the Annals of Surgical Oncology is publishing a series of editorials that highlight the major changes in staging presented in the 7th edition of TNM.
ajcc cancer staging manual 7th edition pdf free
Publication of the 7th edition of the AJCC Cancer Staging Manual comes at a major watershed for cancer staging and the AJCC. First, the revolution in understanding cancer biology is dramatically altering clinical oncology. Historically, cancer staging and treatment planning was based solely on the anatomic extent of the cancer. Anatomy continues to be a key prognostic factor for cancer, and anatomic-based staging will remain critically important. However the rapidly increasing specific knowledge of cancer biology provides prognostic information that complements and in some cases is more relevant than anatomic extent. This information must be incorporated into cancer prognostic models, and into the TNM nomenclature, if staging systems are to remain useful for patients and clinicians. Maintaining clear systems for defining anatomic stage while including biologic prognostic information is a key challenge and opportunity for the AJCC.
The AJCC is also working closely with the cancer surveillance community and specialty organizations to define and implement clinical instruments that collect data in the format needed to transmit stage, store, and use stage and prognostic data. Beginning in 2004, the AJCC and its cancer surveillance partners implemented a data collection tool across all US hospital and population registries for cancer stage information, called the Collaborative Stage Data Collection System (CS).3 This uses a standardized data dictionary to collect information on T, N, M, and site-specific prognostic and predictive factors. The CS system includes the computer algorithms to derive TNM stage. The CS system is built into all cancer registry software systems in the USA. The primary data and derived stage are stored locally at the hospital registry and are also transmitted to central registries including state registries, SEER, and the National Cancer Data Base (NCDB). This data collection and storage tool may be expanded in the future to incorporate new factors relevant to cancer prognosis. It is also designed for an interoperable electronic environment to allow use of the CS primary staging elements and the CS-derived TNM cancer stage in other electronic platforms.
A key feature of the 7th edition of TNM is coordination with the UICC. This is critical to maintain a single, worldwide system for recording and communicating cancer stage. This is particularly important, as cancer becomes one of the leading causes of death around the world. UICC representatives participated on all of the AJCC disease site taskforces. There were major international collaborations for data collection and analysis to revise TNM, which included the establishment of international data collection efforts in a number of diseases. Among these were a worldwide collaboration and database for lung cancer staging led by the International Association for the Study of Lung Cancer, a Worldwide Esophageal Cancer Collaboration, and the melanoma taskforce. Other major international collaborations led to the unification of gastric cancer staging across Asia, Europe, and North America, and coordination with the International Federation of Gynecology and Obstetric (FIGO) for staging of gynecologic malignancies. The AJCC manual and UICC manual were fully coordinated to be sure any issues were coordinated. Finally, the AJCC and UICC carefully reviewed the rules for TNM staging to ensure a uniform and clear approach to staging.
The AJCC believes that this 7th edition of the AJCC Cancer Staging Manual will enhance the utility of the TNM staging to patients and clinicians. We hope that this series of editorials in the Annals of Surgical Oncology will further assist clinicians in understanding staging, and the changes made in TNM. However, publication of the 7th edition is just the next step. The 7th edition is also a springboard to the exciting future of personalized cancer care using data to more specifically define prognosis and the potential for benefit from specific therapies. The AJCC will lead the charge to bring scientific advances to broad clinical use to provide these advantages to all cancer patients worldwide.
Importance Although an accurate uveal melanoma staging system is needed to improve research and patient care, the evaluation of eye cancer staging systems requires international multicenter data sharing to acquire a statistically significant analysis.
Main Outcomes and Measures Metastasis after initial tumor staging with 5- and 10-year Kaplan-Meier metastasis-free point estimates, depending on AJCC prognostic stages I through IV, tumor size category, and subclassification (defined by the presence of ciliary body involvement and/or extrascleral extension).
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After someone is diagnosed with breast cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
Details of the TNM staging system Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. The categories below use the pathologic (surgical) definitions.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven't been sure how much these tiny deposits of cancer cells influence outlook.
Abstract: Intrahepatic cholangiocarcinoma accounts for 5% to 30% of all primary liver cancers, and its incidence has increased in the last 3 decades. Surgical resection remains the only potentially curative treatment but is associated with high tumor recurrence rates. The 7th edition of the American Joint Committee on Cancer (AJCC) Staging Manual introduced a new staging system for intrahepatic cholangiocarcinoma, which was previously staged the same as hepatocellular carcinoma. The recently published 8th edition has subdivided the T1 category to T1a and T1b based on a size cutoff of 5 cm, removed periductal invasion from the T4 category, and downstaged T4 tumors and regional lymph node metastasis from stage IV to IIIB. Continued international efforts to accurately stratify prognosis are important to counsel patients and guide treatment decisions.
Intrahepatic cholangiocarcinoma is the second most common primary liver cancer after hepatocellular carcinoma and is increasing in incidence worldwide (1). Surgical resection is the only potentially curative therapy and results in 5-year overall survival rates between 15% and 40% (2). Unfortunately, disease relapse after resection occurs in up to two-thirds of patients (3). Prognostic factors associated with higher recurrence include positive surgical margin, lymph node metastasis, vascular invasion, and multiple tumors (4,5). The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system represents a standard for stratifying patients with cancer, predicting prognosis, and guiding treatment decisions (6). The recently published 8th edition of the AJCC Staging Manual represents the first revision of the previously novel staging of intrahepatic cholangiocarcinoma introduced in the 7th edition (7). Before the 7th edition, intrahepatic cholangiocarcinoma shared the same staging as hepatocellular carcinoma.
In the 7th edition, intrahepatic cholangiocarcinoma with regional lymph node metastasis was classified as stage IVA. In surgical series, up to one-third of patients have node-positive disease (22). For the 8th edition, regional lymph node metastasis was downstaged from IVA to IIIB. A challenge with the N1 category in intrahepatic cholangiocarcinoma is that routine lymphadenectomy is not standardized across institutions. According to an analysis of the Surveillance, Epidemiology, and End Results (SEER) database, information on lymph node status was available in only 49% of patients undergoing resection of intrahepatic cholangiocarcinoma (23). In addition, there are no guidelines on the minimum number of lymph nodes that should be harvested. In the 8th edition of the AJCC staging of intrahepatic cholangiocarcinoma, recovery of at least 6 lymph nodes is recommended for complete nodal staging, consistent with recommendations for gallbladder cancer. 2ff7e9595c