43555683 TNM Staging of Head and Neck Cancer Neck Dissection Classification
Staging Moments Head Neck 1
Transcript of Staging Moments Head Neck 1
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AJCC Staging Moments
AJCC TNM Staging 7th Edition
Glottic Larynx Case #1
Contributors:Jatin P. Shah, MD Memorial Sloan-Kettering Cancer Center, New York, New YorkCarol R. Bradford, MD University of Michigan Medical Center, Ann Arbor, Michigan
James Brierley, MB Princess Margaret Hospital/University Health Network, Toronto, Ontario
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Larynx Case # 1Presentation of New Case
Newly diagnosed larynx cancer patient
Presentation at Cancer Conference for treatmentrecommendations and clinical staging
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Larynx Case # 1History & Physical
63 yr old female who presented with a raspyvoice, no palpable lymphadenopathy
No smoking hx
No family history of ca
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Larynx Case # 1Diagnostic Procedure
Procedure Biopsy left vocal cord during laryngoscopy with
operating microscope
Pathology Report Well differentiated squamous cell ca Grade 1
HPV status is negative
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Larynx Case # 1Clinical Staging
Clinical staging Uses information from the physical exam, imaging,
and diagnostic biopsy
Purpose Select appropriate treatment Estimate prognosis
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Larynx Case # 1Clinical Staging
Synopsis- patient with small lesion on left vocalcord, clinically negative lymph nodes
What is the clinical stage? T____ N____
M____ Stage Group______
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Larynx Case # 1Clinical Staging
Clinical Stage correct answer T1a N0 M0 Stage Group I
Based on stage and other factors, treatment isselected
Review NCCN treatment guidelines for this stage
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Prognostic FactorsClinically Significant
Applicable to this case
Human papillomavirus (HPV) status: neg
HPV is less prevalent in laryngeal cancer thanoropharyngeal cancers
There are no prognostic factors required forstaging
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Larynx Case # 1Presentation after Surgery
The choice of treatment lies between Definitive external beam radiotherapy Endoscopic laser resection Open partial laryngectomy
The procedure chosen based on patient factors and thelesion confined to one vocal cord and clinically negativenodes, Stage I, is partial laryngectomy
Presentation at Cancer Conference for adjuvanttreatment recommendations and pathologic staging
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Larynx Case # 1Surgery & Findings
Procedure Partial laryngectomy
Operative findings No additional information
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Larynx Case # 1Pathology Results
Squamous cell carcinoma, involving lt vocal cord Tumor size - 1.2cm Grade - moderately differentiated Maximal thickness - 0.7cm Invades lamina propria Extension to anterior commissure Margins negative 4 regional nodes negative
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Larynx 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 estimating prognosis Calculating end results (survival data)
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Larynx Case # 1Pathologic Staging
Synopsis- patient with 1.2cm lt vocal cord lesionextending to the anterior commissure, regionalnodes negative
What is the pathologic stage?(remember, clinical M may be used in pathologic staging)
T____
N____ M____ Stage Group______
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Larynx Case # 1Pathologic Staging
Pathologic Stage correct answer pT1a pN0 cM0 Stage Group I
Based on pathologic stage, there is moreinformation to estimate prognosis and forselection of adjuvant treatment.
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Larynx Case # 1Pathologic Staging
Rationale for staging choices pT1a for tumor limited to one vocal cord (may involve
anterior or posterior commissure) with normal mobility
pN0 because regional nodes were negative
cM0 - use clinical M with pathologic staging unlessthere is pathologic confirmation of distant metastases
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Prognostic FactorsClinically Significant
Applicable to this case
Size of lymph nodes: n/a
Extracapsular extension from lymph nodes: n/a
Lymph node levels involved: n/a
Extracapsular spread (ECS) pathologic: n/a
Human papillomavirus (HPV) status: neg
There are no prognostic factors required for staging
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AJCC Cancer Staging AtlasT1 limited to vocal cord(s),
normal mobility
T1a one vocal cord
T1b both vocal cords
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Larynx Case # 1Recap of Staging
Summary of correct answers Clinical stage T1a N0 M0 Stage Group I Pathologic stage T1a N0 cM0 Stage Group I
The staging classifications have a different purposeand therefore can be different. Do not go back and
change the clinical staging based on pathologicstaging information.
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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 for selection of adjuvant treatment and prognosis Used to evaluate end-results (survival)