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
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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.
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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 Mary Kay Washington, MD Vanderbilt University Medical Center, Nashville, Tennessee
Jose Guillem, MD Memorial Sloan-Kettering Cancer Center, New York, New YorkFrederick L. Greene, MD Carolinas Medical Center, Charlotte, North Carolina
Colon Case # 1Presentation of New Case
• Newly diagnosed colon cancer patient
• Presentation at Cancer Conference for treatment recommendations and clinical staging
Colon Case # 1History & Physical
• 51 yr old female who presented with an abnormal screening colonoscopy
• Family history of colon ca
Colon Case # 1Imaging & Endoscopy Results
• Colonoscopy-1.5cm pedunculated polyp at 60cm in transverse colon
• CT abd/pelvis-negative
used with permissionwww.gihealth.com
Colon Case # 1Diagnostic Procedure
• Procedure– Polypectomy, transverse colon at 60cm
• Pathology Report– Adenocarcinoma– Grade 2-3– Invasion into lamina propria– Stalk margins widely free, clear by 4mm
Colon Case # 1Clinical Staging
• Clinical staging – Uses information from the physical exam, imaging,
• Based on pathologic stage, there is more information to estimate prognosis and adjuvant treatment is selected
Colon Case # 1Pathologic 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
Prognostic FactorsClinically Significant
• Applicable to this case
– Pre-op or Pre-Rx CEA: not done
• There are no prognostic factors required for staging
AJCC Cancer Staging AtlasTis Ca in situ or invasion of lamina propriaT1 invades submucosa
Colon Case # 1Recap 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.
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)