AMERICAN JOINT COMMITTEE ON CANCER AJCC CANCER STAGING

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1 AMERICAN JOINT COMMITTEE ON CANCER AJCC CANCER STAGING ATLAS

2 EDITORS FREDERICK L. GREENE, m.d. Chair, Department of General Surgery Carolinas Medical Center Charlotte, North Carolina CAROLYN C. COMPTON, m.d., ph.d Director of Biorepositories and Biospeciment Research National Cancer Institute Bethesda, Maryland APRIL G. FRITZ, c.t.r., r.h.i.t. Division of Cancer Control and Population Sciences National Cancer Institute Bethesda, Maryland JATIN P. SHAH, m.d. Chief, Head and Neck Service Memorial Sloan-Kettering Cancer Center New York, New York DAVID P. WINCHESTER, m.d. Professor and Chair, Department of Surgery Evanston Northwestern Healthcare Evanston, Illinois

3 AJCC CANCER STAGING ATLAS AMERICAN JOINT COMMITTEE ON CANCER Executive Office 633 North Saint Clair Street Chicago, Illinois FOUNDING ORGANIZATIONS American Cancer Society American College of Physicians American College of Radiology American College of Surgeons College of American Pathologists National Cancer Institute SPONSORING ORGANIZATIONS American Cancer Society American College of Surgeons American Society of Clinical Oncology Centers for Disease Control and Prevention LIAISON ORGANIZATIONS American Urological Association Association of American Cancer Institutes National Cancer Registrars Association North American Association of Central Cancer Registries American Society of Colon and Rectal Surgeons Society of Gynecologic Oncologists Society of Urologic Oncology

4 American Joint Committee on Cancer Executive Office 633 North Saint Clair Street Chicago, IL 60611, USA Editors: Frederick L. Greene, M.D. Carolyn C. Compton, M.D., PH.D. April G. Fritz, C.T.R., R.H.I.T. Jatin P. Shan, M.D. David P. Winchester, M.D. Illustrator: Alice Y. Chen This atlas was prepared and published through the support of the American Cancer Society, the American College of Surgeons, the American Society of Clinical Oncology, the Centers for Disease Control and Prevention, and the International Union Against Cancer. Library of Congress Control Number: ISBN-10: ISBN-13: Printed on acid-free paper Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed in the United States of America springeronline.com (BS/EB)

5 Preface This first edition of the AJCC Cancer Staging Atlas has been created as a compendium to the AJCC Cancer Staging Manual and Handbook which have now been developed through six editions and which continue to promulgate the importance of anatomical and pathological staging in the management of cancer. This Atlas has been viewed as a companion to illustrate the TNM classifications of all the regions included under the head and neck, digestive, thoracic, musculoskeletal, soft tissue, breast, genital, urinary and gynecologic sites. This monograph has been fully illustrated to give meaningful visualization to the TNM classifications and stage groupings and will serve as a useful reference for the clinician and patient alike. Since there have been changes in staging strategies in the 6th Edition of the AJCC Cancer Staging Manual, the differences between the 5th edition and 6th edition have been included throughout the Atlas. This will provide a meaningful comparison for the experienced clinician as well as serve as a teaching reference for the student and trainee. The 432 outstanding illustrations have been developed exclusively for the AJCC Cancer Staging Atlas by Alice Y. Chen, our exceptional medical illustrator. Every illustration provides detailed and thorough anatomic depictions to clarify critical structures and to allow the reader to instantly visualize the progressive extent of malignant disease. Appropriate labeling has been incorporated to identify significant anatomic structures. A significant number (28%) of the illustrations are devoted solely to the representation of the TNM changes which are new in the AJCC Cancer Staging Manual, 6th Edition. Throughout all anatomic sites, the newly developed illustrations reflect concepts that are more completely discussed in the AJCC Cancer Staging Manual and Handbook. The AJCC Cancer Staging Atlas is an official publication of the American Joint Committee on Cancer and reinforces the AJCC s position as the leader in disseminating state of the art information on TNM staging. The AJCC continues to have as its mission the education of physicians, registrars and patients. The Atlas, a portable and easily referenced representation of the AJCC monographs, continues to enhance this mission. This project has been fully supported by our publishing colleagues at Springer and especially Laura dizerega and Bill Curtis, our longtime friends and AJCC supporters. The editors of this most recent AJCC project wish to reinforce the concept that TNM is a universal language which must be applied by all clinicians caring for the cancer patients. In order to make this language come alive, a pictorial representation of clinical and pathological staging is necessary. We dedicate this work to all of our patients and colleagues and hope that they too will benefit from this illustrated resource. Frederick L. Greene, m.d. Carolyn C. Compton, m.d., ph.d. April G. Fritz, c.t.r., r.h.i.t. Jatin P. Shah, m.d. David P. Winchester, m.d. American Joint Committee on Cancer 2006 v

6 Contents Preface v 1. Purposes and Principles of Staging Part I Head and Neck Sites 2. Introduction to Head and Neck Sites Lip and Oral Cavity Pharynx (Including Base of Tongue, Soft Palate, and Uvula) Larynx Nasal Cavity and Paranasal Sinuses Major Salivary Glands (Parotid, Submandibular, and Sublingual) Thyroid Part II Digestive System 9. Esophagus Stomach Small Intestine Colon and Rectum Anal Canal Liver (Including Intrahepatic Bile Ducts) Gallbladder Extrahepatic Bile Ducts Ampulla of Vater Exocrine Pancreas American Joint Committee on Cancer 2006 vii

7 Part III Thorax 19. Lung Pleural Mesothelioma Part IV Musculoskeletal Sites 21. Bone Soft Tissue Sarcoma Part V Skin 23. Carcinoma of the Skin (Excluding Eyelid, Vulva, and Penis) Melanoma of the Skin Part VI Breast 25. Breast Part VII Gynecologic Sites 26. Vulva Vagina Cervix Uteri Corpus Uteri Ovary Fallopian Tube Gestational Trophoblastic Tumors Part VIII Genitourinary Sites 33. Penis Prostate viii American Joint Committee on Cancer 2006

8 35. Testis Kidney Renal Pelvis and Ureter Urinary Bladder Urethra Index American Joint Committee on Cancer 2006 ix