Scott H. Kurtzman

Colon and Rectum

In the sixth edition, Stage II was subdivided into IIA and IIB on the basis of whether the primary tumor was T3N0 or T4N0, respectively, and Stage III was subdivided into IIIA (T1-2N1M0), IIIB (T3-4N1M0), or IIIC (any TN2M0). In the seventh edition, further substaging of Stage II and III has been accomplished, based on survival and relapse data that was not available for the prior edition

Exocrine and Endocrine Pancreas

Pancreatic neuroendocrine tumors (including carcinoid tumors) are now staged by a single pancreatic staging system

Lip and Oral Cavity

T4 lesions have been divided into T4a (moderately advanced local disease) and T4b (very advanced local disease), leading to the stratification of Stage IV into Stage IVA (moderately advanced local/regional disease), Stage IVB (very advanced local/regional disease), and Stage IVC (distant metastatic disease)

Esophagus and Esophagogastric Junction

Tumor location is simplified, and esophagogastric junction and proximal 5 cm of stomach are included Tis is redefined and T4 is subclassified Regional lymph nodes are redefined. N is subclassified according to the number of regional lymph nodes containing metastasis M is redefined Separate stage groupings for squamous cell carcinoma and adenocarcinoma Stage groupings are reassigned using T, N, M, and G classifications

Cutaneous Squamous Cell Carcinoma and Other Cutaneous Carcinomas

Primary Site. Cutaneous squamous cell and other carcinomas can occur anywhere on the skin. Cutaneous SCC and BCC most commonly arise on anatomic sites that have been exposed to sunlight. Cutaneous SCC can also arise in skin that was previously scarred or ulcerated – that is, at sites of burns and chronic ulcers (chronic inflammation). All of the components of the skin (epidermis, dermis, and adnexal structures) can give rise to malignant neoplasms.

Melanoma of the Skin

Melanoma of the skin is a malignant tumor of melanocytes, the pigment-producing cells that are situated normally at the basal layer of the epidermis. Melanoma incidence and mortality rates are increasing in many countries of the world. This, combined with concern about the added effect of ozone depletion on these rates in the future, has focused attention on the need for public and professional education programs on the prevention and early detection of this tumor.

Perihilar Bile Ducts

Extrahepatic bile duct tumors have been separated into perihilar (proximal) and distal groups and separate staging classifications defined for each T1 (confined to bile duct) and T2 (beyond the wall of the bile duct) have been specified histologically T1 (confined to bile duct) and T2 (beyond the wall of the bile duct) have been specified histologically T2 includes invasion of adjacent hepatic parenchyma T3 is defined as unilateral vascular invasion

Ovary and Primary Peritoneal Carcinoma

Primary Site. The ovaries are a pair of solid, flattened ovoids 2–4 cm in diameter that are connected by a peritoneal fold to the broad ligament and by the infundibulopelvic ligament to the lateral wall of the pelvis (Figure 37.1). They are attached medially to the uterus by the utero-ovarian ligament.

Purposes and Principles of Cancer Staging

The extent or stage of cancer at the time of diagnosis is a key factor that defines prognosis and is a critical element in determining appropriate treatment based on the experience and outcomes of groups of prior patients with similar stage. In addition, accurate staging is necessary to evaluate the results of treatments and clinical trials, to facilitate the exchange and comparison of information among treatment centers, and to serve as a basis for clinical and translational cancer research. At a national and international level, the agreement on classifications of cancer cases provides a method of clearly conveying clinical experience to others without ambiguity.

Merkel cell carcinoma

Merkel cell carcinomas (MCCs) are rare cutaneous neuroendocrine neoplasms that are clinically aggressive due to a relatively high local, regional, and distant metastatic recurrence potential. They are found most commonly in Caucasian (94 %), elderly patients, with an average age at presentation being approximately 72 years. The most common sites of involvement include the head and neck (46–48 %), followed by the extremities (35–38 %), and trunk (11–17 %). Given their relatively non-specific clinical presentation, diagnosis is often delayed leading to advanced disease at the time of diagnosis. Management involves surgical excision with consideration of adjuvant therapy (radiation and/or chemotherapy) for regional or distant metastatic disease.