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AJCC Staging Moments

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

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AJCC Staging Moments

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  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. Colon Case # 1 Presentation after Surgery • Patient had polypectomy during their screening colonoscopy • This patient was recommended for observation only, no further treatment

  12. 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)

  13. 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______

  14. 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

  15. 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

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

  17. AJCC Cancer Staging Atlas Tis Ca in situ or invasion of lamina propria T1 invades submucosa

  18. 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.

  19. 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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