Setting the Stage for 2018: How the Changes in the American Joint Committee on Cancer/Union for International Cancer Control Cancer Staging Manual Eighth Edition Impact Radiologists

Fellows’ Journal Club

The updated eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer will be implemented in January 2018. There are multiple changes to the head and neck section of the manual, which will be relevant to radiologists participating in multidisciplinary head and neck tumor boards and reading pretreatment head and neck cancer scans.

Figure 3 from paper
Two patients with nasopharyngeal carcinoma. A and B, A 64-year-old man with a nasopharyngeal mass found incidentally on PET/CT and determined to be EBV(+) undifferentiated nonkeratinizing carcinoma. Axial T1 postcontrast fat-saturated images (A and B) demonstrate an asymmetric nasopharyngeal mass with lateral extension to the right masticator space lateral pterygoid muscle. In the seventh edition, this would be T4 disease; however, in the eighth edition, this is only T2 disease. Note however that in this patient, there is also involvement of the pterygoid plates, which is now clarified as T3 disease, and superior extension to the right cavernous sinus, which is T4 disease in both AJCC Cancer Staging Manual seventh and eighth editions. C and D, A 15-year-old boy presenting with epistaxis and a large mass arising from the nasopharynx determined to be EBV(+) undifferentiated nonkeratinizing carcinoma. Sagittal T1 (C) shows the large mass filling the nasopharynx, extending inferiorly to the oropharynx and anteriorly to the nasal cavity. Axial postcontrast T1 with fat saturation (D) shows lateral extension of the mass into the masticator space but also to the left parotid gland. In the eighth edition, involvement of the parotid gland or extension of tumor beyond the lateral surface of the lateral pterygoid muscle determines T4 status.

SUMMARY

The updated eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer will be implemented in January 2018. There are multiple changes to the head and neck section of the manual, which will be relevant to radiologists participating in multidisciplinary head and neck tumor boards and reading pretreatment head and neck cancer scans. Human papillomavirus–related/p16(+) oropharyngeal squamous cell carcinoma will now be staged separately; this change reflects the markedly better prognosis of these tumors compared with non-human papillomavirus/p16(−) oropharyngeal squamous cell carcinoma. Nodal staging has dramatically changed so that there are different tables for human papillomavirus/p16(+) oropharyngeal squamous cell carcinoma, Epstein-Barr virus–related nasopharyngeal carcinoma, and all other head and neck squamous cell carcinomas. Extranodal extension of tumor is a new clinical feature for this third staging group. In the oral cavity, the pathologically determined depth of tumor invasion is a new staging criterion, while extrinsic tongue muscle invasion is no longer part of staging. This review serves to educate radiologists on the eighth edition changes and their rationale.

Read this article: http://bit.ly/2BBAtJn

Setting the Stage for 2018: How the Changes in the American Joint Committee on Cancer/Union for International Cancer Control Cancer Staging Manual Eighth Edition Impact Radiologists
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jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.

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