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AJCC Staging Moments. AJCC TNM Staging 7th Edition Colon Case #2. Contributors: J. Milburn Jessup, MD Cancer Diagnosis Program, DCTD, NCI, Rockville, Maryland Mary Kay Washington, MD Vanderbilt University Medical Center, Nashville, Tennessee

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ajcc staging moments

AJCC Staging Moments

AJCC TNM Staging 7th Edition

Colon Case #2

  • Contributors:
  • J. Milburn Jessup, MD Cancer Diagnosis Program, DCTD, NCI, Rockville, Maryland
  • Mary Kay Washington, MD Vanderbilt University Medical Center, Nashville, Tennessee
    • Jose Guillem, MD Memorial Sloan-Kettering Cancer Center, New York, New York
    • Frederick L. Greene, MD Carolinas Medical Center, Charlotte, North Carolina
colon case 2 presentation of new case
Colon Case # 2 Presentation of New Case
  • Newly diagnosed colon cancer patient
  • Presentation at Cancer Conference for treatment recommendations and clinical staging
colon case 2 history physical
Colon Case # 2 History & Physical
  • 55 yr old female who presented with possible appendicitis
  • No family history of any cancer
colon case 2 imaging endoscopy results
Colon Case # 2 Imaging & Endoscopy Results
  • CT abd/pelvis-prominent pericecal nodes not diagnostic
  • Colonoscopy-large circumferential mass in cecum

used with permission

Julio Murra-Saca, MD

El Savador Atlas of Gastrointestinal Video Endoscopy

colon case 2 diagnostic procedure
Colon Case # 2 Diagnostic Procedure
  • Procedure
    • Colonoscopy & biopsy
  • Pathology Report
    • Adenocarcinoma, invasive
    • Grade 2
  • Pre-op CEA was 1.7
colon case 2 clinical staging
Colon Case # 2 Clinical Staging
  • Clinical staging
    • Uses information from the physical exam, imaging, and diagnostic biopsy
  • Purpose
    • Select appropriate treatment
    • Estimate prognosis
colon case 2 clinical staging1
Colon Case # 2 Clinical Staging
  • Synopsis- patient with large cecal mass, clinically negative nodes
  • What is the clinical stage?
    • T____
    • N____
    • M____
    • Stage Group______
colon case 2 clinical staging2
Colon Case # 2 Clinical Staging
  • Clinical Stage correct answer
    • TX
    • N0
    • M0
    • Stage Group unknown
  • Based on stage, treatment is selected
  • Review NCCN treatment guidelines for this stage
colon case 2 clinical staging3
Colon Case # 2 Clinical Staging
  • Rationale for staging choices
    • TX for cannot be assessed
    • N0 because nodes were clinically negative on imaging
    • M0 because there was nothing to suggest distant metastases; if there was, appropriate tests would be performed before developing a treatment plan
prognostic factors clinically significant
Prognostic Factors Clinically Significant
  • Applicable to this case
    • CEA: 1.7
  • There are no prognostic factors required for staging
colon case 2 presentation after surgery
Colon Case # 2 Presentation after Surgery
  • The procedure chosen based on the large cecal mass with no nodes or distant spread, Stage unknown, is resection
  • Presentation at Cancer Conference for treatment recommendations and pathologic staging
colon case 2 surgery findings
Colon Case # 2 Surgery & Findings
  • Procedure
    • Right hemicolectomy
  • Pre-op CEA was 1.7
  • Operative findings
    • Mobile cecum without retroperitoneal invasion
    • No palpable liver metastases
colon case 2 pathology results
Colon Case # 2 Pathology Results
  • Adenocarcinoma, cecum
  • Size of tumor - 4.2cm
  • Grade 2
  • Penetrates through wall into mesentery with perforation and perforates visceral peritoneum
  • Margins negative
  • Circumferential resection margin was clear by 3mm
  • 12 mesenteric nodes negative
  • There was no perineural or lymph-vascular invasion
  • Tumor deposits were not identified
colon case 2 pathologic staging
Colon Case # 2 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)
colon case 2 pathologic staging1
Colon Case # 2 Pathologic Staging
  • Synopsis- patient with 4.2cm cecal mass perforating mesentery and visceral peritoneum, nodes negative
  • What is the pathologic stage?(remember, clinical M may be used in pathologic staging)
    • T____
    • N____
    • M____
    • Stage Group______
colon case 2 pathologic staging2
Colon Case # 2 Pathologic Staging
  • Pathologic Stage correct answer
    • pT4a
    • pN0
    • cM0
    • Stage Group IIB
  • Based on pathologic stage, there is more information to estimate prognosis and adjuvant treatment is discussed
colon case 2 pathologic staging3
Colon Case # 2 Pathologic Staging
  • Rationale for staging choices
    • pT4a is penetrates to surface of visceral peritoneum
    • pN0 because mesenteric nodes were negative
    • cM0 - use clinical M with pathologic staging unless there is pathologic confirmation of distant metastases
prognostic factors clinically significant1
Prognostic Factors Clinically Significant
  • Applicable to this case
    • CEA: 1.7
    • Circumferential resection margin: 3mm
    • Tumor deposits: no
    • Perineural invasion: no
  • There are no prognostic factors required for staging
slide20
AJCC Cancer Staging Atlas T4 directly invades other organs or structures, and/or perforates visceral peritoneum
colon case 2 recap of staging
Colon Case # 2 Recap of Staging
  • Summary of correct answers
    • Clinical stage TX N0 M0 Stage Group unknown
    • Pathologic stage T4a N0 cM0 Stage Group IIB
  • 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.
staging moments summary
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)
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