AJCC 8th & In Service

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Does anyone know if the next in-service 3/2017 is using AJCC 8th staging?
 
Is there a reputable link for a quick run-down of "What has changed" broken up by disease site or diagnosis? One website reviewing the AJCC annual meeting is just an hour of non-useful blah blah.
 
Anyone seen where we can purchase the AJCC 8 online? I can only find the 1,000 page hardcover for like $100 bucks. All I want is the handbook - have they not released it yet? Anyone know of an online free resource to peek at the new staging?

Thanks
 
Our H&N-pathologist gave us an update today after the tumor-board.
The H&N-TNM has sone ... interesting changes.

Different stages for N-disease based on clinical (cN) or pathology (pN) report?
N-stage in oropharynx cancer directly linked to p16-status?

Why keep it simple, if you can make it complicated...
 
Palex80 said:
Our H&N-pathologist gave us an update today after the tumor-board.
The H&N-TNM has sone ... interesting changes.

Different stages for N-disease based on clinical (cN) or pathology (pN) report?
N-stage in oropharynx cancer directly linked to p16-status?

Why keep it simple, if you can make it complicated...
Click to expand...

One step ahead of ICD-15!
 
Palex80 said:
Our H&N-pathologist gave us an update today after the tumor-board.
The H&N-TNM has sone ... interesting changes.

Different stages for N-disease based on clinical (cN) or pathology (pN) report?
N-stage in oropharynx cancer directly linked to p16-status?

Why keep it simple, if you can make it complicated...
Click to expand...

Oh god. Not the cN vs pN crap like they did when they did it with breast cancer. What about patients who have definitive chemoRT without pathologic staging? At least in non-metastatic breast, there's a surgery happening at some point so there will always be some amount of pathologic staging (whether it's p or yp)

N-stage directly linked to p16? I imagine that p16 for HPV+ would be associated into the staging like how PSA factors in for prostate, or Grade for Esophageal SCC. Don't see why HPV+ should change the actual N staging of TNM.
I was expecting p16+ staging (basically knowing what combination of TNM translates into what stage) would be simpler given that so many subsets had survival on the order of a stage I or II even with massively locally advanced disease.

Now I'm much more curious.
 
evilbooyaa said:
Oh god. Not the cN vs pN crap like they did when they did it with breast cancer. What about patients who have definitive chemoRT without pathologic staging? At least in non-metastatic breast, there's a surgery happening at some point so there will always be some amount of pathologic staging (whether it's p or yp)

N-stage directly linked to p16? I imagine that p16 for HPV+ would be associated into the staging like how PSA factors in for prostate, or Grade for Esophageal SCC. Don't see why HPV+ should change the actual N staging of TNM.
I was expecting p16+ staging (basically knowing what combination of TNM translates into what stage) would be simpler given that so many subsets had survival on the order of a stage I or II even with massively locally advanced disease.

Now I'm much more curious.
Click to expand...

I purchased the manual thinking I would need it for this year. For p16 (+) , there are indeed distinct clinical and pathologic N-stages as well as distinct clinical and pathologic overall stage grouping.

cN1: one or more ipsi node(s) </= 6 cm
cN2: contralateral or bilateral nodes </= 6 cm
cN3: node(s) > 6 cm

pN1: </= 4 nodes
pN2: > 4 nodes

There's also now slightly different clinical and pathologic N-staging for other H&N sites.

cN3b = clinical ENE

pN2a = single ipsi node with pathologic ENE and size </= 3 cm
pN3b = single ipsi node with pathologic ENE and size > 3 cm or multiple ipsi, contralateral, or bilateral nodes with pathologic ENE.
 
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CptCrunch said:
I purchased the manual thinking I would need it for this year. For p16 (+) , there are indeed distinct clinical and pathologic N-stages as well as distinct clinical and pathologic overall stage grouping.

cN1: one or more ipsi node(s) </= 6 cm
cN2: contralateral or bilateral nodes </= 6 cm
cN3: node(s) > 6 cm

pN1: </= 4 nodes
pN2: > 4 nodes

There's also now slightly different clinical and pathologic N-staging for other H&N sites.

cN3b = clinical ENE

pN2a = single ipsi node with pathologic ENE and size </= 3 cm
pN3b = single ipsi node with pathologic ENE and size > 3 cm or multiple ipsi, contralateral, or bilateral nodes with pathologic ENE.
Click to expand...

<=4 nodes? Does it matter how many nodes were taken in all? Does it matter if they're unilateral or bilateral (in setting of B/L neck dissections)?

Clinical ENE? How do you define that? CT-based? Need an MRI to make that call? The FDG-avidity on PET/CT (exaggerating on this one)? There's going to be a number of patients that are cN1 vs cN3b based off a radiologist read about 'extranodal extension cannot be excluded'.

I'm OK with pathologic ENE being included in pathological staging given the decisions it makes for us regarding adding chemo to adjuvant RT.

Any chance you can go through all of the a's and b's of pathologic nodal staging? What's pN2b? what's pN1b? what's pN3a?
 
Is there any information as to whether we need to know AJCC 8th edition for the 2018 oral boards (not this year)?
 
mcrue said:
Is there any information as to whether we need to know AJCC 8th edition for the 2018 oral boards (not this year)?
Click to expand...

Yes. At this point, the ABR is adopting AJCC8 for all exams (clinical written and oral) beginning in 2018.

On another note, AJCC7 stands for all diagnoses made through Dec 31 2017. All diagnoses made after Jan 1 2018 will be AJCC8
 
evilbooyaa said:
<=4 nodes? Does it matter how many nodes were taken in all? Does it matter if they're unilateral or bilateral (in setting of B/L neck dissections)?

Clinical ENE? How do you define that? CT-based? Need an MRI to make that call? The FDG-avidity on PET/CT (exaggerating on this one)? There's going to be a number of patients that are cN1 vs cN3b based off a radiologist read about 'extranodal extension cannot be excluded'.

I'm OK with pathologic ENE being included in pathological staging given the decisions it makes for us regarding adding chemo to adjuvant RT.

Any chance you can go through all of the a's and b's of pathologic nodal staging? What's pN2b? what's pN1b? what's pN3a?
Click to expand...

In general the head and neck changes are as follows:
There is the introduction of a new TNM system for p16+ oropharynx as mentioned. The T stage is identical to p16- with the exception being that T4 is not broken down into T4a or T4b. There is additionally a clinical and pathologic nodal stage which was mentioned above. There is also a separate stage grouping for clinical and pathological staging.

For the rest of head and neck, the nodal staging has changed a bit. In the absence of ENE it is unchanged. However, if there is CLINICAL ENE (defined as being OVERT ENE based on clinical exam or imaging) it is automatically cN3b (N3b is a new N stage).

Pathologically, in the absence of ENE it is unchanged. However, in the presence of ENE, a single node < 3cm is now pN2. ENE with ANYTHING MORE than a single node < 3cm is pN3b. That means that [ENE] + [Single ipsilateral node > 3cm OR multiple ipsilateral nodes OR bilateral nodes OR contralateral nodes] is N3b. Stage grouping is unchanged (N3a vs. N3b does not alter stage grouping)

For Lip/OC, DOI was added as a criteria for T staging.
T1 = <=2 cm with DOI <= 5mm
T2 = <=2cm with DOI 5-10mm OR 2-4cm with DOI < 10mm
T3 = Tumor > 4cm OR DOI > 10mm

The last change is in nasopharynx.
Adjacent muscle involvement (medial/lateral pterygoids and prevertebral muscles) is now T2 (was T4)
N3a and N3b were merged into a single N3 category and the definition of N3 is now any lymph nodes below the caudal border of the cricoid cartilage

p16+ H&N of unknown primary should follow the p16+ OPX system whereas p16- should follow the standard H&N Unknown Primary staging

There's a number of other changes pertinent to us.
 
Thanks for the synopsis. Will be interesting on the definitions of clinical ENE. Fixed neck mass = clinical ENE? I get that matted nodes or a big conglomerate certainly makes us think ENE clinically. I wonder if NCCN is going to recommend ENE in single node < 3cm (pN2) gets RT w/o chemo like our surgeons are pushing for in tumor board week to week.

Glad to see DOI incorporated into T staging for OC.
 
With the implementation being next month, curious if people are sucking it up and purchasing this piece of crap hardcover full of typos or waiting for the updated version? Anyone know when the updated is coming out? Or the paperback, smaller handbook?
 
napoleondynamite said:
With the implementation being next month, curious if people are sucking it up and purchasing this piece of crap hardcover full of typos or waiting for the updated version? Anyone know when the updated is coming out? Or the paperback, smaller handbook?
Click to expand...

Full of typos? Any specific areas? I have the giant version now sitting on my desk (thanks for the answers at the beginning of 2017!), and have only used it to panic over the insane way that breast cancer is now going to be staged. And the updates to HPV+ OroPhx. and Oral Cavity as above.

I asked at a small meeting where they were selling the giant 8th edition (at beginning of 2017) and was told that "they aren't making a small one". Could've just been a push to get me to buy the book right then and there, but just what I heard.
 
Typos. Check the insane stage grouping table for breast cancer. Then try to stage a T3N0 tumor going through all grades and receptor statuses.
 
So the consensus is that for THIS in-service 3/2018, we're doing AJCC 8th for sure, right?
 
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“The ACR TXIT Exam Committee, which governs the exam program, has indicated that staging questions will be somewhat deemphasized on this year’s exam relative to typical past years. Additionally, those staging items that do get included on the exam will largely focus on specifying the changes between the two Staging systems (i.e. the 7th edition vs. the 8th edition).”

There are a number of questions on ROQ about differences between 7th and 8th edition staging. A lot of them are tripping me up significantly.
 
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