AJCC Cancer Staging 8 th edition Lip and Oral Cavity Oropharynx (p16 -) and Hypopharynx Larynx
AJCC 7 th edition Lip and Oral cavity Pharynx Larynx
KEY CHANGES
Skin of head and neck (Vermilion of the lip) Lip and oral cavity Oral cavity (Mucosal of the lip)
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
Nasopharynx Pharynx HPV-Mediated (p16 +) Oropharyngeal Cancer Oropharynx (p16 -) Hypopharynx
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
N stage Separate clinical and pathological N stage Extranodal extension (ENE) add into N category Separated N stage in HPV-associated oropharyngeal carcinoma
LIP AND ORAL CAVITY ALL EPITHELIAL & MINOR SALIVARY GLAND CANCER
Vermilion of lip belongs to skin cancer (Ch.15)
Tumor size: actual measurement of the unfixed tumor
Tumor thickness Depth of invasion Tumor thickness DOI
How about exophytic tumor? No conclusion!
How to determine the horizontal line? No conclusion!
Key concept of DOI How much depth comparing to normal mucosa!
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
Note: Superficial erosion of bone / tooth socket is insufficient to classify as T4
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
Additional regional LN group: Suboccipital Retropharyngeal Parapharyngeal Buccinator (fascial) Preauricular Select neck dissection >10 LN Radical neck dissection >15 LN Periparotid and intraparotid
ENE (-) ENEn None ENE (+) ENEmi ENEma Microscopic ENE 2mm ENE > 2mm or gross ENE
Size of invasive carcinoma in lymph node
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
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
N T Is 1 2 3 4a 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
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
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
Worst Pattern of Invasion (WPOI)-5 Tumor dispersion of 1 mm between tumor satellites. 1 mm
Definition of WPOI-5 Tumor dispersion of 1mm between tumor satellite. Tumor dispersion through soft tissue. Disperse extratumoral perineural invasion. Extratumoral lymphovascular invasion.
WPOI-5 Strandy pattern with intervening skeletal muscle WPOI-5 Often associated with PNI
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%
Wrapping around nerves Perineural invasion Bumping into a nerve Insufficient for perineural invasion
Lymphovascular invasion Should be reported as Either intratumoral or extratumoral Focal or multifocal
OROPHARYNX (P16 -) & HYPOPHARYNX ALL EPITHELIAL (P16 -) & MINOR SALIVARY GLAND CANCER
No change in anatomical site
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
Oropharynx (p16 -) Tumor size: actual measurement of the unfixed tumor T1 T2 T3 2 cm > 2-4 cm > 4 cm
T4a Larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, mandible T4b Lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base / encases carotid artery
Hypopharynx Pyriform sinuses Post-cricoid region Lateral and posterior hypopharyngeal wall
Hypopharynx T1 Tumor 2 cm, limited to 1 subsite
Hypopharynx Subsite: Pyriform sinuses Lateral and posterior hypopharyngeal wall Postcricoid region T2 Tumor > 2-4 cm, invade >1 subsites
Hypopharynx T3 Tumor > 4cm / fixation of hemilarynx / extension to esophagus mucosa
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
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
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
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
N T Is 1 2 3 4a 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
Additional Prognostic Factors Recommended for Clinical Care Extranodal Extension Overall health Comorbidity Lifestyle factor Tobacco Use
LARYNX CARCINOMA OF THE SUPPRAGLOTTIC, GLOTTIC & SUBGLOTTIC LARYNX
Supraglottic Glottic Subglottic Suprahyoid epiglottis Infrahyoid epiglottis AE fold / arytenoids Ventricular band True vocal cord Subglottic
Supraglottis T1 Tumor limited to 1 subsite T2 Tumor invades > 1 subsites / glottis / region outside the supraglottis
Supraglottis T1 Tumor limited to 1 subsite T2 Tumor invades > 1 subsites / glottis / region outside the supraglottis
Supraglottis Tumor limited to larynx with vocal cord fixation / invades postcricoid area, preepiglottic space, paraglottic space, inner cortex of thyroid cortex T3
Glottis T1a Limited to 1 vocal cord T1b Invalves both vocal cords
Glottis T2 Extends to supraglottis / subglottis Impaired vocal cord mobility
Glottis T3 Vocal cord fixation Invasion of paraglottic space/ inner cortex of thyroid cartilage
Subglottis T1 Tumor limited to the subglottis
Subglottis T2 Tumor extends to vocal cord(s)
Subglottis T3 Vocal cord fixation Invasion of paraglottic space/ inner cortex of thyroid cartilage
Supraglottis / Glottis / Subglottis T4a Tumor invades through the outer cortex of the thyroid cartilage / invades tissue beyond the larynx
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
Supraglottis / Glottis / Subglottis T4b Invades prevertebral space Encases carotid artery Invades mediastinal structure
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
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
N T Is 1 2 3 4a 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
Additional Prognostic Factors Recommended for Clinical Care Extranodal Extension Comorbidity Lifestyle factor Tobacco Use
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