AJCC Staging Moments

1. AJCC Staging Moments AJCC TNM Staging 7th Edition Colon Case #1

2. Colon Case # 1 Presentation of New Case Newly diagnosed colon cancer patient Presentation at Cancer Conference for treatment recommendations and clinical staging

3. Colon Case # 1 History & Physical 51 yr old female who presented with an abnormal screening colonoscopy Family history of colon ca

4. Colon Case # 1 Imaging & Endoscopy Results Colonoscopy-1.5cm pedunculated polyp at 60cm in transverse colon CT abd/pelvis-negative

5. Colon Case # 1 Diagnostic Procedure Procedure Polypectomy, transverse colon at 60cm Pathology Report Adenocarcinoma Grade 2-3 Invasion into lamina propria Stalk margins widely free, clear by 4mm

6. Colon Case # 1 Clinical Staging Clinical staging Uses information from the physical exam, imaging, and diagnostic biopsy Purpose Select appropriate treatment Estimate prognosis

7. Colon Case # 1 Clinical Staging Synopsis- patient with 1.5cm pedunculated polyp resected on screening colonoscopy, nodes negative on imaging What is the clinical stage? T____ N____ M____ Stage Group______

8. Colon Case # 1 Clinical Staging Clinical Stage correct answer pTis cN0 cM0 Stage Group 0 Based on stage, treatment is selected Review NCCN treatment guidelines for this stage

9. Colon Case # 1 Clinical Staging Rationale for staging choices pTis Invasion of lamina propria Pathologic since the stalk margin was clear cN0 because nodes were clinically negative on imaging 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 Pre-op or Pre-Rx CEA: not done There are no prognostic factors required for staging

12. Colon Case # 1 Presentation after Surgery Patient had polypectomy during their screening colonoscopy This patient was recommended for observation only, no further treatment

13. Colon Case # 1 Pathologic Staging Pathologic staging Uses information from the clinical staging supplemented or modified by information from surgery and the pathology report Purpose Additional precise data for estimating prognosis Calculating end results (survival data)

14. Colon Case # 1 Pathologic Staging Synopsis- patient with polyp resected on screening colonoscopy What is the pathologic stage?(remember, clinical M may be used in pathologic staging) T____ N____ M____ Stage Group______

15. Colon Case # 1 Pathologic Staging Pathologic Stage correct answer pTis cN0 cM0 Stage Group 0 Based on pathologic stage, there is more information to estimate prognosis and adjuvant treatment is selected

16. Colon Case # 1 Pathologic Staging Rationale for staging choices pTis because Invasion of lamina propria Pathologic since the stalk margin was clear cN0 – nodes were negative on imaging so this is clinical, but can be used in insitu cases only cM0 – use clinical M with pathologic staging unless there is pathologic confirmation of distant metastases AJCC 7th Edition Chapter 1, p12, allow pTis cN0 cM0 to be both a clinical Stage Group 0 and a pathologic Stage Group 0

17. Prognostic Factors Clinically Significant Applicable to this case Pre-op or Pre-Rx CEA: not done There are no prognostic factors required for staging

18. AJCC Cancer Staging Atlas Tis Ca in situ or invasion of lamina propria T1 invades submucosa

19. Colon Case # 1 Recap of Staging Summary of correct answers Clinical stage pTis cN0 cM0 Stage Group 0 Pathologic stage pTis cN0 cM0 Stage Group 0 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.

20. 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 to evaluate end-results (survival)