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AJCC Staging Moments

AJCC Staging Moments. AJCC TNM Staging 7th Edition Supraglottic Larynx Case #2. Contributors: Jatin P. Shah, MD Memorial Sloan-Kettering Cancer Center, New York, New York Carol R. Bradford, MD University of Michigan Medical Center, Ann Arbor, Michigan

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AJCC Staging Moments

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  1. AJCC Staging Moments AJCC TNM Staging 7th Edition Supraglottic Larynx Case #2 Contributors: Jatin P. Shah, MD Memorial Sloan-Kettering Cancer Center, New York, New York Carol R. Bradford, MD University of Michigan Medical Center, Ann Arbor, Michigan James Brierley, MB Princess Margaret Hospital/University Health Network, Toronto, Ontario

  2. Larynx Case # 2 Presentation of New Case • Newly diagnosed larynx cancer patient • Presentation at Cancer Conference for treatment recommendations and clinical staging

  3. Larynx Case # 2 History & Physical • 73 yr old male who presented with chronic hoarseness, SOB, dysphagia • No smoking hx • No family history of ca

  4. Larynx Case # 2 Imaging & Endoscopy Results • CT neck • Right laryngeal region mass with • Extension to paraglottic space • Prominent 1.4cm level III right necknode • CT chest and CT brain • Negative • Laryngoscopy & bx • Large tumor involving right false vocal cord extending to true vocal cord and medial wall of pyriform sinus on the same side • Vocal cord is mobile • No contralateral spread Used with permission. Becker, M, Moulin G, Kurt A, et al. Atypical Sqamous Cell Carcinoma of the Larynx and Hypopharynx: Radiologic Features. European Radiology. 1998; 8:1544.

  5. Larynx Case # 2 Diagnostic Procedure • Procedure • Biopsy right false vocal cord during laryngoscopy • Pathology Report • Squamous cell ca • Poorly differentiated, Grade 3 • Human papillomavirus (HPV) - neg

  6. Larynx Case # 2 Clinical Staging • Clinical staging • Uses information from the physical exam, imaging, and diagnostic laryngoscopy • Purpose • Select appropriate treatment • Estimate prognosis

  7. Larynx Case # 2 Clinical Staging • Synopsis- patient with supraglottic lesion extending to glottis, medial wall of pyriform sinus with normal vocal cord mobility, clinically involved nodes • What is the clinical stage? • T____ • N____ • M____ • Stage Group______

  8. Larynx Case # 2 Clinical Staging • Clinical Stage correct answer • cT2 • cN1 • cM0 • Stage Group III • Based on stage, treatment is selected • Review NCCN treatment guidelines for this stage

  9. Larynx Case # 2 Clinical Staging • Rationale for staging choices • cT2 • Invades more than one adjacent subsite • Invades region outside supraglottis (pyriform sinus) • Vocal cord is mobile • No cartilage invasion • cN1 because a single ipsilateral lymph node <3 cm was clinically positive on imaging studies • cM0 because there was nothing to suggest distant metastases; if there was, appropriate tests would be performed before developing a treatment plan

  10. Prognostic Factors Clinically Significant • Applicable to this case • Head & Neck nodes Level: III • Clinical location of cervical nodes: above level of cricoid and medial to lateral border of SCM • Extracapsular spread (ECS) clinical: neg • Human papillomavirus (HPV) status: neg • There are no prognostic factors required for staging

  11. Larynx Case # 2 Pathologic Staging • This patient was recommended for radiation rx & chemotherapy, no surgery • Pathologic staging is not completed since there was no resection meeting the pathologic classification requirements

  12. Prognostic Factors Clinically Significant • Applicable to this case • Size of lymph nodes: <3cm clinically • Extracapsular extension from lymph nodes: none seen clinically or radiologically • Lymph node levels involved: III • Extracapsular spread (ECS) pathologic: n/a • Human papillomavirus (HPV) status: neg • There are no prognostic factors required for staging

  13. AJCC Cancer Staging Atlas T2 Invasion of more than one adjacent subsite or outside supraglottis

  14. Larynx Case # 2 Recap of Staging • Summary of correct answers • Clinical stage cT2 N1 M0 Stage Group III • Pathologic stage unknown • The staging classifications have a different purpose and therefore can be different. Do not go back and change the clinical staging based on pathologic staging information.

  15. 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)

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