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AJCC Staging Moments

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AJCC Staging Moments AJCC TNM Staging 7th Edition Supraglottic Larynx Case #2 Contributors: Jatin P. Shah, MD Memorial Sloan-Kettering Cancer Center, New York, New York – PowerPoint PPT presentation

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Title: AJCC Staging Moments


1
AJCC Staging Moments
  • AJCC TNM Staging 7th Edition
  • Supraglottic Larynx Case 2

Contributors Jatin P. Shah, MD
Memorial Sloan-Kettering Cancer Center, New York,
New York Carol R. Bradford, MD
University of Michigan Medical Center, Ann Arbor,
Michigan James Brierley, MB Princess
Margaret Hospital/University Health Network,
Toronto, Ontario
2
Larynx Case 2 Presentation of New Case
  • Newly diagnosed larynx cancer patient
  • Presentation at Cancer Conference for treatment
    recommendations and clinical staging

3
Larynx Case 2 History Physical
  • 73 yr old male who presented with chronic
    hoarseness, SOB, dysphagia
  • No smoking hx
  • No family history of ca

4
Larynx Case 2 Imaging Endoscopy Results
  • CT neck
  • Right laryngeal region mass with
  • Extension to paraglottic space
  • Prominent 1.4cm level III right necknode
  • CT chest and CT brain
  • Negative
  • Laryngoscopy bx
  • Large tumor involving right false vocal cord
    extending to true vocal cord and medial wall of
    pyriform sinus on the same side
  • Vocal cord is mobile
  • No contralateral spread

Used with permission. Becker, M, Moulin G, Kurt
A, et al. Atypical Sqamous Cell Carcinoma of the
Larynx and Hypopharynx Radiologic Features.
European Radiology. 1998 81544.
5
Larynx Case 2 Diagnostic Procedure
  • Procedure
  • Biopsy right false vocal cord during laryngoscopy
  • Pathology Report
  • Squamous cell ca
  • Poorly differentiated, Grade 3
  • Human papillomavirus (HPV) - neg

6
Larynx Case 2 Clinical Staging
  • Clinical staging
  • Uses information from the physical exam, imaging,
    and diagnostic laryngoscopy
  • Purpose
  • Select appropriate treatment
  • Estimate prognosis

7
Larynx Case 2 Clinical Staging
  • Synopsis- patient with supraglottic lesion
    extending to glottis, medial wall of pyriform
    sinus with normal vocal cord mobility, clinically
    involved nodes
  • What is the clinical stage?
  • T____
  • N____
  • M____
  • Stage Group______

8
Larynx Case 2 Clinical Staging
  • Clinical Stage correct answer
  • cT2
  • cN1
  • cM0
  • Stage Group III
  • Based on stage, treatment is selected
  • Review NCCN treatment guidelines for this stage

9
Larynx Case 2 Clinical Staging
  • Rationale for staging choices
  • cT2
  • Invades more than one adjacent subsite
  • Invades region outside supraglottis (pyriform
    sinus)
  • Vocal cord is mobile
  • No cartilage invasion
  • cN1 because a single ipsilateral lymph node lt3 cm
    was clinically positive on imaging studies
  • 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
  • Head Neck nodes Level III
  • Clinical location of cervical nodes above level
    of cricoid and medial to lateral border of SCM
  • Extracapsular spread (ECS) clinical neg
  • Human papillomavirus (HPV) status neg
  • There are no prognostic factors required for
    staging

11
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12
Larynx Case 2 Pathologic Staging
  • This patient was recommended for radiation rx
    chemotherapy, no surgery
  • Pathologic staging is not completed since there
    was no resection meeting the pathologic
    classification requirements

13
Prognostic Factors Clinically Significant
  • Applicable to this case
  • Size of lymph nodes lt3cm clinically
  • Extracapsular extension from lymph nodes none
    seen clinically or radiologically
  • Lymph node levels involved III
  • Extracapsular spread (ECS) pathologic n/a
  • Human papillomavirus (HPV) status neg
  • There are no prognostic factors required for
    staging

14
AJCC Cancer Staging Atlas T2 Invasion of more
than one adjacent subsite or
outside supraglottis
15
Larynx Case 2 Recap of Staging
  • Summary of correct answers
  • Clinical stage cT2 N1 M0 Stage Group III
  • Pathologic stage unknown
  • 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.

16
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 for selection of adjuvant treatment and
    prognosis
  • Used to evaluate end-results (survival)
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