Robert K. Brookland

The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging

The American Joint Committee on Cancer (AJCC) staging manual has become the benchmark for classifying patients with cancer, defining prognosis, and determining the best treatment approaches. Many view the primary role of the tumor, lymph node, metastasis (TNM) system as that of a standardized classification system for evaluating cancer at a population level in terms of the extent of disease, both at initial presentation and after surgical treatment, and the overall impact of improvements in cancer treatment. The rapid evolution of knowledge in cancer biology and the discovery and validation of biologic factors that predict cancer outcome and response to treatment with better accuracy have led some cancer experts to question the utility of a TNM‐based approach in clinical care at an individualized patient level. In the Eighth Edition of the AJCC Cancer Staging Manual, the goal of including relevant, nonanatomic (including molecular) factors has been foremost, although changes are made only when there is strong evidence for inclusion. The editorial board viewed this iteration as a proactive effort to continue to build the important bridge from a “population‐based” to a more “personalized” approach to patient classification, one that forms the conceptual framework and foundation of cancer staging in the era of precision molecular oncology. The AJCC promulgates best staging practices through each new edition in an effort to provide cancer care providers with a powerful, knowledge‐based resource for the battle against cancer. In this commentary, the authors highlight the overall organizational and structural changes as well as “whats new” in the Eighth Edition. It is hoped that this information will provide the reader with a better understanding of the rationale behind the aggregate proposed changes and the exciting developments in the upcoming edition. CA Cancer J Clin 2017;67:93–99.

Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck

Risk Assessment Models The AJCC recently established guidelines that will be used to evaluate published statistical prediction models for the purpose of granting endorsement for clinical use. Although this is a monumental step toward the goal of precision medicine, this work was published only very recently. Therefore, the existing models that have been published or may be in clinical use have not yet been evaluated for this cancer site by the Precision Medicine Core of the AJCC. In the future, the statistical prediction models for this cancer site will be evaluated, and those that meet all AJCC criteria will be endorsed.

Soft Tissue Sarcoma of the Head and Neck

Risk Assessment Models The AJCC recently established guidelines that will be used to evaluate published statistical prediction models for the purpose of granting endorsement for clinical use. Although this is a monumental step toward the goal of precision medicine, this work was published only very recently. Therefore, the existing models that have been published or may be in clinical use have not yet been evaluated for this cancer site by the Precision Medicine Core of the AJCC. In the future, the statistical prediction models for this cancer site will be evaluated, and those that meet all AJCC criteria will be endorsed.

Neuroendocrine Tumors of the Jejunum and Ileum

AJCC Cancer Staging Manual, 8th Edition Copyright 2016 American Joint Committee on Cancer. All rights reserved. Version 1 | Page 1 of 2 Authors Eugene A. Woltering, Emily K. Bergsland, David T. Beyer, Thomas M. O’Dorisio, Guido Rindi, David S. Klimstra, Laura H. Tang, Diane Reidy-Lagunes, Jonathan R. Strosberg, Edward M. Wolin, Aaron I. Vinik, Eric K. Nakakura, Elliot A. Asare, David L. Bushnell, Richard L. Schilsky, Yi-Zarn Wang, Michelle K. Kim, Eric H. Liu, Robert T. Jensen, Rebecca K.S. Wong, John K. Ramage, Kathy Mallin, Rodney F. Pommier

Adrenal Cortical Carcinoma

A review of 28 cases of adrenal cortical carcinoma provides some insights into the natural history of this disease and suggests modifications in current techniques of diagnosis and management. Our patients ranged in age from 1 to 69 years but it is notable that all of our male patients were more than 39 years old. In addition the men tended to have high stage tumors that were nonfunctional. Female patients, on the other hand, were more evenly distributed in terms of stage, function and age at diagnosis. Staging was extremely important and is discussed in some detail. A dismayingly large number of patients were found to have stage 3 or 4 tumor at initial diagnosis, suggesting that aggressive and rapid evaluation and a high index of suspicion are important to optimize survival. Function is helpful but non-function is common and should not dissuade one from the diagnosis. Excretory urography with tomography followed by angiography frequently will provide the diagnosis. Endocrinologic evaluation should be done with alacrity. Survival with high stages of disease is poor and lengthy evaluation should not be allowed to delay prompt and, hopefully, curative surgery. Surgical resection is the key to cure; chemotherapy and radiotherapy provided relatively poor results in our hands although mitotane has shown a 34 to 54 per cent response rate.Objective To study the diagnosis and treatment of adrenal cortical carcinoma. MethodsBZFifteen cases of adrenal cortical carcinoma (8 functional and 7 nonfunctional) were treated surgically during the period of 19781998. They were confirmed operatively and pathologically. Results The functional carcinoma usually showed typical clinical features such as Cushings syndrome, primary aldosteronism, and adrenogenital syndrome. The nonfunctional had extraadrenal symptoms such as actue abdominal pain and hypertension.A definite diagnosis can be made by the measurements of urine 17ketosteroid, 17hydrosteroid, cortisol, aldosterone, CT, and Bultrasonography. Conclusions Surgical removal of the tumor is the only effective treatment. Early diagnosis of adrenal cortical carcinoma is very difficult, especially in the nonfunctional.