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AJCC Staging Moments

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AJCC Staging Moments AJCC TNM Staging 7th Edition Colon Case #1 Contributors: J. Milburn Jessup, MD Cancer Diagnosis Program, DCTD, NCI, Rockville, Maryland – PowerPoint PPT presentation

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Title: AJCC Staging Moments


1
AJCC Staging Moments
  • AJCC TNM Staging 7th Edition
  • Colon Case 1

Contributors J. Milburn Jessup, MD
Cancer Diagnosis Program, DCTD, NCI, Rockville,
Maryland Mary Kay Washington, MD
Vanderbilt University Medical Center, Nashville,
Tennessee Jose Guillem, MD Memorial
Sloan-Kettering Cancer Center, New York, New
York Frederick L. Greene, MD Carolinas Medical
Center, Charlotte, North Carolina
2
Colon Case 1 Presentation of New Case
  • Newly diagnosed colon cancer patient
  • Presentation at Cancer Conference for treatment
    recommendations and clinical staging

3
Colon Case 1 History Physical
  • 51 yr old female who presented with an abnormal
    screening colonoscopy
  • Family history of colon ca

4
Colon Case 1 Imaging Endoscopy Results
  • Colonoscopy-1.5cm pedunculated polyp at 60cm in
    transverse colon
  • CT abd/pelvis-negative

used with permission www.gihealth.com
5
Colon Case 1 Diagnostic Procedure
  • Procedure
  • Polypectomy, transverse colon at 60cm
  • Pathology Report
  • Adenocarcinoma
  • Grade 2-3
  • Invasion into lamina propria
  • Stalk margins widely free, clear by 4mm

6
Colon Case 1 Clinical Staging
  • Clinical staging
  • Uses information from the physical exam, imaging,
    and diagnostic biopsy
  • Purpose
  • Select appropriate treatment
  • Estimate prognosis

7
Colon Case 1 Clinical Staging
  • Synopsis- patient with 1.5cm pedunculated polyp
    resected on screening colonoscopy, nodes negative
    on imaging
  • What is the clinical stage?
  • T____
  • N____
  • M____
  • Stage Group______

8
Colon Case 1 Clinical Staging
  • Clinical Stage correct answer
  • pTis
  • cN0
  • cM0
  • Stage Group 0
  • Based on stage, treatment is selected
  • Review NCCN treatment guidelines for this stage

9
Colon Case 1 Clinical Staging
  • Rationale for staging choices
  • pTis
  • Invasion of lamina propria
  • Pathologic since the stalk margin was clear
  • cN0 because nodes were clinically negative on
    imaging
  • cM0 because there was nothing to suggest distant
    metastases if there was, appropriate tests would
    be performed before developing a treatment plan

10
Prognostic Factors Clinically Significant
  • Applicable to this case
  • Pre-op or Pre-Rx CEA not done
  • There are no prognostic factors required for
    staging

11
(No Transcript)
12
Colon Case 1 Presentation after Surgery
  • Patient had polypectomy during their screening
    colonoscopy
  • This patient was recommended for observation
    only, no further treatment

13
Colon Case 1 Pathologic Staging
  • Pathologic staging
  • Uses information from the clinical staging
    supplemented or modified by information from
    surgery and the pathology report
  • Purpose
  • Additional precise data for estimating prognosis
  • Calculating end results (survival data)

14
Colon Case 1 Pathologic Staging
  • Synopsis- patient with polyp resected on
    screening colonoscopy
  • What is the pathologic stage?(remember, clinical
    M may be used in pathologic staging)
  • T____
  • N____
  • M____
  • Stage Group______

15
Colon Case 1 Pathologic Staging
  • Pathologic Stage correct answer
  • pTis
  • cN0
  • cM0
  • Stage Group 0
  • Based on pathologic stage, there is more
    information to estimate prognosis and adjuvant
    treatment is selected

16
Colon Case 1 Pathologic Staging
  • Rationale for staging choices
  • pTis because
  • Invasion of lamina propria
  • Pathologic since the stalk margin was clear
  • cN0 nodes were negative on imaging so this is
    clinical, but can be used in insitu cases only
  • cM0 use clinical M with pathologic staging
    unless there is pathologic confirmation of
    distant metastases
  • AJCC 7th Edition Chapter 1, p12, allow pTis cN0
    cM0 to be both a clinical Stage Group 0 and a
    pathologic Stage Group 0

17
Prognostic Factors Clinically Significant
  • Applicable to this case
  • Pre-op or Pre-Rx CEA not done
  • There are no prognostic factors required for
    staging

18
AJCC Cancer Staging Atlas Tis Ca in situ or
invasion of lamina propria T1 invades submucosa
19
Colon Case 1 Recap of Staging
  • Summary of correct answers
  • Clinical stage pTis cN0 cM0 Stage Group 0
  • Pathologic stage pTis cN0 cM0 Stage Group 0
  • The staging classifications have a different
    purpose and therefore can be different. Do not
    go back and change the clinical staging based on
    pathologic staging information.

20
Staging Moments Summary
  • Review site-specific information if needed
  • Clinical Staging
  • Based on information before treatment
  • Used to select treatment options
  • Pathologic Staging
  • Based on clinical data PLUS surgery and pathology
    report information
  • Used to evaluate end-results (survival)
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