AJCC Staging Moments.ppt

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

2、 York, New York Frederick 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 if there was, appropriate

3、 tests would be performed before developing a treatment plan,Prognostic FactorsClinically Significant,Applicable to this case Pre-op or Pre-Rx CEA: not done There are no prognostic factors required for staging,Colon Case # 1Presentation after Surgery,Patient had polypectomy during their screening co

4、lonoscopy This patient was recommended for observation only, no further treatment,Colon Case # 1Pathologic 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 estimatin

5、g prognosis Calculating end results (survival data),Colon Case # 1Pathologic 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_,Colon Case # 1Pathologic Staging,Pathologic

6、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,Colon Case # 1Pathologic Staging,Rationale for staging choices pTis because Invasion of lamina propria Pathologic since the stalk margin was c

7、lear 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 pat

8、hologic 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

9、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 selec