The revised American Joint Committee on Cancer (AJCC) Cancer Staging Manual was recently released with a new staging system for all cancer cases diagnosed on or after January 1, 2018. The 8th edition of the Cancer Staging Manual represents an important step in refining the anatomic staging system traditionally based on primary tumor extent and nodal and distant metastasis (TNM) by including non-anatomic factors in prognostic groupings. While the TNM components remain purely anatomic, many of the staging algorithms in the 8th edition of the Cancer Staging Manual incorporate molecular and serologic factors into new staging systems designed to reflect the current state of medical knowledge and the natural history and prognosis of cancers. Some of the noteworthy advances in this edition include:
- The incorporation of human papilloma virus (HPV) status, based on p16 immunohistochemistry, into staging systems for oropharyngeal carcinoma to reflect the better prognosis of HPV-related cancers at this site.
- The removal of lobular carcinoma in situ, now regarded as a benign entity from TNM staging for breast cancer.
- The inclusion of hormone receptor and HER2 assays and multigene panels such as Mammaprint and Oncotype Dx as stage modifiers (when available) into Prognostic Stage Groups for breast carcinoma.
- Placing a greater emphasis on the anatomic primary site of soft tissue sarcomas with new staging systems for retroperitoneal, head and neck and visceral sarcomas designed to reflect differences in local recurrence and metastatic disease propensities related to site.
- The refinement of the staging system for carcinomas of the exocrine pancreas by basing T category definitions on tumor size and involvement of arteries, resulting in more objective definitions that show better correlation with survival.
The College of American Pathologists (CAP) Cancer Protocols are being revised to incorporate the changes to the staging systems. These structured report templates are used by many pathology departments, including the home departments of the CHTN divisions, to report findings in cancer resection specimens. While these advances in staging primarily benefit patients and clinicians, biorepositories and their users will also benefit from easier access to important prognostic information that will now be included in surgical pathology reports. The inclusion of such data will reduce the amount of time and staff required for manual data extraction from the patient's chart and eliminate the need for chart review in some instances. The net result is improved patient care and, to CHTN users, access to more complete pathologic data at no increase in cost! Learn more @https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/.
- Amin MB, Edge SB, Greene FL, Brookland RK, et al, eds. AJCC Cancer staging Manual, 8th edition. Springer: Philadelphia, 2017.