AJCC Cancer Staging 8 th edition. Lip and Oral Cavity Oropharynx (p16 -) and Hypopharynx Larynx
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1 AJCC Cancer Staging 8 th edition Lip and Oral Cavity Oropharynx (p16 -) and Hypopharynx Larynx
2 AJCC 7 th edition Lip and Oral cavity Pharynx Larynx
3 KEY CHANGES
4 Skin of head and neck (Vermilion of the lip) Lip and oral cavity Oral cavity (Mucosal of the lip)
5 Oral cavity Depth of Invasion (DOI) add into T category Delete invasion of extrinsic muscle of tongue in T category Instead, bilateral tongue involvement is added
6 Nasopharynx Pharynx HPV-Mediated (p16 +) Oropharyngeal Cancer Oropharynx (p16 -) Hypopharynx
7 Nasopharynx HPV-Mediated (p16 +) Oropharyngeal Cancer T0 category Separate staging algorithm for HPVassociated cancer Oropharynx (p16 -) Hypopharynx No T0 category New chapter for cervical lymph node and unknown primary tumors
8 N stage Separate clinical and pathological N stage Extranodal extension (ENE) add into N category Separated N stage in HPV-associated oropharyngeal carcinoma
9 LIP AND ORAL CAVITY ALL EPITHELIAL & MINOR SALIVARY GLAND CANCER
10 Vermilion of lip belongs to skin cancer (Ch.15)
11 Tumor size: actual measurement of the unfixed tumor
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14 Tumor thickness Depth of invasion Tumor thickness DOI
15 How about exophytic tumor? No conclusion!
16 How to determine the horizontal line? No conclusion!
17 Key concept of DOI How much depth comparing to normal mucosa!
18 DOI Tumor size 2 cm >2-4 cm >4 cm 5 mm T1 T2 T3 >5-10mm T2 T2 T3 >10 mm T3 T3 T3 >20mm T4a T4a T4a
19 Note: Superficial erosion of bone / tooth socket is insufficient to classify as T4
20 Lip: Through cortical bone, inferior alveolar n. floor of mouth, skin of the face T4a Oral cavity: Adjacent structure(s) only (Through cortical bone, maxillary sinus, skin of the face, extrinsic muscle of tongue Bilateral tongue involvement) T4b Masticator space, pterygoid plates, skull base / encases the internal carotid artery
21 Additional regional LN group: Suboccipital Retropharyngeal Parapharyngeal Buccinator (fascial) Preauricular Select neck dissection >10 LN Radical neck dissection >15 LN Periparotid and intraparotid
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23 ENE (-) ENEn None ENE (+) ENEmi ENEma Microscopic ENE 2mm ENE > 2mm or gross ENE
24 Size of invasive carcinoma in lymph node
25 Without ENE LN number LN size 3 cm >3-6 cm >6 cm 1 N1 N2a N3a >1 N2b N2b Contralateral / Bilateral N2c N2c N3a
26 With ENE LN number LN size 3 cm >3-6 cm >6 cm 1 N2a N3b N3b >1 N3b N3b N3b Contralateral / Bilateral N3b N3b N3b
27 N T Is a 4b M1 0 0 I II III IVA IVB IVC 1 III III III IVA IVB IVC 2 IVA IVA IVA IVA IVB IVC 3 IVB IVB IVB IVB IVB IVC M1 IVC IVC IVC IVC IVC IVC
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32 Additional Prognostic Factors Recommended for Clinical Care Extranodal extension Depth of invasion Resection margins Worst pattern of invasion Perineural invasion Lymphovascular invasion Overall health Comorbidity Lifestyle factor Tobacco Use
33 Additional Prognostic Factors Recommended for Clinical Care Extranodal extension Depth of invasion Resection margins Worst pattern of invasion Perineural invasion Lymphovascular invasion Overall health Comorbidity Lifestyle factor Tobacco Use
34 Worst Pattern of Invasion (WPOI)-5 Tumor dispersion of 1 mm between tumor satellites. 1 mm
35 Definition of WPOI-5 Tumor dispersion of 1mm between tumor satellite. Tumor dispersion through soft tissue. Disperse extratumoral perineural invasion. Extratumoral lymphovascular invasion.
36 WPOI-5 Strandy pattern with intervening skeletal muscle WPOI-5 Often associated with PNI
37 Significance of WPOI-5 Stage I/II OSCC, primary tumor > 4mm DOI. Significantly predictive of locoregional recurrence and disease specific survival. The probability in developing locoregional recurrence is 42%
38 Wrapping around nerves Perineural invasion Bumping into a nerve Insufficient for perineural invasion
39 Lymphovascular invasion Should be reported as Either intratumoral or extratumoral Focal or multifocal
40 OROPHARYNX (P16 -) & HYPOPHARYNX ALL EPITHELIAL (P16 -) & MINOR SALIVARY GLAND CANCER
41 No change in anatomical site
42 Oropharyngeal Squamous cell carcinoma P16 IHC stain (75%) + - / Not performed Squamous cell carcioma, HPV-positive Grading is not advocated Squamous cell carcioma, HPV-negative Similar grading to other sites
43 Oropharynx (p16 -) Tumor size: actual measurement of the unfixed tumor T1 T2 T3 2 cm > 2-4 cm > 4 cm
44 T4a Larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, mandible T4b Lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base / encases carotid artery
45 Hypopharynx Pyriform sinuses Post-cricoid region Lateral and posterior hypopharyngeal wall
46 Hypopharynx T1 Tumor 2 cm, limited to 1 subsite
47 Hypopharynx Subsite: Pyriform sinuses Lateral and posterior hypopharyngeal wall Postcricoid region T2 Tumor > 2-4 cm, invade >1 subsites
48 Hypopharynx T3 Tumor > 4cm / fixation of hemilarynx / extension to esophagus mucosa
49 Subsite Tumor size 2 cm >2-4 cm >4 cm 1 T1 T2 T3 >1 T2 T2 T3 Fixation of hemilarynx / Invasion of esophagus mucosa T3 T3 T3
50 Hypopharynx T4a Thyroid/cricoid cartilage, hyoid bone, thyroid gland, central compartment soft tissue, esophageal muscular wall T4b Prevertebral fascia Encases carotid artery Involves mediastinal structures
51 Without ENE LN number LN size 3 cm >3-6 cm >6 cm 1 N1 N2a N3a >1 N2b N2b Contralateral / Bilateral N2c N2c N3a
52 With ENE LN number LN size 3 cm >3-6 cm >6 cm 1 N2a N3b N3b >1 N3b N3b N3b Contralateral / Bilateral N3b N3b N3b
53 N T Is a 4b M1 0 0 I II III IVA IVB IVC 1 III III III IVA IVB IVC 2 IVA IVA IVA IVA IVB IVC 3 IVB IVB IVB IVB IVB IVC M1 IVC IVC IVC IVC IVC IVC
54 Additional Prognostic Factors Recommended for Clinical Care Extranodal Extension Overall health Comorbidity Lifestyle factor Tobacco Use
55 LARYNX CARCINOMA OF THE SUPPRAGLOTTIC, GLOTTIC & SUBGLOTTIC LARYNX
56 Supraglottic Glottic Subglottic Suprahyoid epiglottis Infrahyoid epiglottis AE fold / arytenoids Ventricular band True vocal cord Subglottic
57 Supraglottis T1 Tumor limited to 1 subsite T2 Tumor invades > 1 subsites / glottis / region outside the supraglottis
58 Supraglottis T1 Tumor limited to 1 subsite T2 Tumor invades > 1 subsites / glottis / region outside the supraglottis
59 Supraglottis Tumor limited to larynx with vocal cord fixation / invades postcricoid area, preepiglottic space, paraglottic space, inner cortex of thyroid cortex T3
60 Glottis T1a Limited to 1 vocal cord T1b Invalves both vocal cords
61 Glottis T2 Extends to supraglottis / subglottis Impaired vocal cord mobility
62 Glottis T3 Vocal cord fixation Invasion of paraglottic space/ inner cortex of thyroid cartilage
63 Subglottis T1 Tumor limited to the subglottis
64 Subglottis T2 Tumor extends to vocal cord(s)
65 Subglottis T3 Vocal cord fixation Invasion of paraglottic space/ inner cortex of thyroid cartilage
66 Supraglottis / Glottis / Subglottis T4a Tumor invades through the outer cortex of the thyroid cartilage / invades tissue beyond the larynx
67 Beyond the larynx Supraglottis Glottis Subglottis Trachea Soft tissue of neck Deep extrinsic muscle of the tongue Strap muscle Thyroid Esophagus Trachea Cricoid cartilage Soft tissue of neck Deep extrinsic muscle of the tongue Strap muscles Thyroid Esophagus Trachea Soft tissue of neck Deep extrinsic muscle of the tongue Strap muscles Thyroid Esophagus
68 Supraglottis / Glottis / Subglottis T4b Invades prevertebral space Encases carotid artery Invades mediastinal structure
69 Without ENE LN number LN size 3 cm >3-6 cm >6 cm 1 N1 N2a N3a >1 N2b N2b Contralateral / Bilateral N2c N2c N3a
70 With ENE LN number LN size 3 cm >3-6 cm >6 cm 1 N2a N3b N3b >1 N3b N3b N3b Contralateral / Bilateral N3b N3b N3b
71 N T Is a 4b M1 0 0 I II III IVA IVB IVC 1 III III III IVA IVB IVC 2 IVA IVA IVA IVA IVB IVC 3 IVB IVB IVB IVB IVB IVC M1 IVC IVC IVC IVC IVC IVC
72 Additional Prognostic Factors Recommended for Clinical Care Extranodal Extension Comorbidity Lifestyle factor Tobacco Use
73 Thank you for your attention!
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