Content from AJCC's Cancer Staging Manual, 7th edition, has been licensed for use in the application programming interface (API) by NPCR. The AJCC Cancer Staging System is the preeminent paradigm used by physicians The Seventh Edition of the AJCC Cancer Staging Handbook brings the. TX Primary tumor cannot be assessed, or tumor T2 Tumor more than 3 cm but 7 cm or less or Financial support for AJCC 7th Edition Staging Posters.
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We do recognize that being overly inclusive with regards to high-risk sites could be problematic, as the associated risk is not uniform across all locations. However, we agree with Warner and Cockerell that the ajcc cancer staging 7th face and dorsal hands and feet warrant strong consideration for subsequent editions [ 2 ].
One of the most important risk factors associated with cSCC is host immune status.
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Numerous studies have displayed the significant impact immunosuppression ajcc cancer staging 7th on both the incidence and biologic characteristics of cSCC [ 53738 ]. While the authors of the 7th edition acknowledge the impact immune status has on prognosis, they chose not to include it, as TNM staging is focused primarily on tumor characteristics rather than host factors.
Moreover, by not including this high-risk variable, the current system misses a subset of patients who, despite having tumors small in size, are likely to experience an aggressive clinical course [ 38 ]. The short-term metastatic rate for these lesions is roughly 25 percent, while the overall metastatic rate approaches 40 percent [ 5 ].
Recurrent disease is an additional factor worth noting. The presence of recurrent or persistent disease is a strong prognostic variable for metastasis and control of ajcc cancer staging 7th disease [ 541 ].
Journal of Skin Cancer
As a result, a subset of high-risk lesions are clearly defined as such, and data ajcc cancer staging 7th for these tumors is significantly enhanced. However, in light of most recent changes to T staging criteria, a recurrent neoplasm less than 2 cm with only 1 of the three high-risk features would be classified as a Stage I neoplasm rather than Stage II, despite its less favorable prognosis.
Given this, we feel that recurrent or previously treated neoplasms should be included among the high-risk features capable of upstaging a neoplasm. Changes in Advanced T Stage Designation In the 7th edition staging manual, T3 tumors are now classified as those with bony extension to ajcc cancer staging 7th mandible, maxilla, temple, or orbit whereas the T4 designation is reserved for perineural involvement of the skull base or bony extension to the axial or appendicular skeleton.
More practical than previous versions, these specific designations represent an attempt to achieve greater congruence with head and neck cancer guidelines [ 3 ].
A drawback to the new guidelines pertaining to advanced T stage is the inclusion of appendicular skeletal involvement with T4 ajcc cancer staging 7th.
TNM staging system
It seems inappropriate to assign the same prognosis to an SCC invading the small bones of the hand or foot with one displaying perineural involvement of the skull base [ 239 ]. Similarly, under this system, a neoplasm with bony extension into the hand or foot would be assigned a higher classification than one invading the maxilla, mandible, temple, or orbit, a distinction that seems largely inappropriate.
In ajcc cancer staging 7th, as T4 neoplasms are automatically classified as Stage IV, there is the potential for patients to be given a significantly worse prognosis, and subsequently a more aggressive treatment regimen, than their primary cancer may warrant.
As advocated by Warner ajcc cancer staging 7th Cockerell, we feel that appendicular bone involvement should be grouped with T3 lesions rather than T4 [ 2 ].
Although not a significant issue, a potential drawback of the new T stages as they currently stand is that only cSCC arising on the head or neck is capable of receiving T3 classification.
While this likely represents an attempt to achieve greater congruence with the head and neck staging protocol, it seems awkwardly restrictive, ajcc cancer staging 7th for guidelines pertaining to the entire external body surface. Changes in Stratification of Lymph Node Status The nodal N staging system has been completely revised compared to previous editions.
In the past, only the presence or absence of nodal metastasis was recorded, leaving no way to differentiate a patient with sentinel node involvement versus a patient with bilateral multinodal disease [ 539 ].
In the new guidelines, node size, number of involved nodes, and the presence ajcc cancer staging 7th contralateral or bilateral node involvement are all included to better stratify patients.
AJCC Cancer Staging 7th Edition
The inclusion of these variables is the result of significant evidence that prognosis decreases with advancing nodal burden [ 42 ]. Under the new guidelines Table 3ajcc cancer staging 7th to a single node less than 3 cm in greatest dimension is defined as N1.
The N2 designation refers to either a single node 3—6 cm in size, or multinodal disease where no individual node is greater than 6 cm in size. Based on the specific pattern of nodal involvement, N2 is subcategorized into three separate groupings.
Involvement of a single ipsilateral node is categorized as N2a, metastasis to multiple ipsilateral nodes as N2b, ajcc cancer staging 7th involvement of contralateral or bilateral lymph nodes as N2c.
The N3 designation is reserved for any lymph node greater than 6 cm in greatest dimension, regardless of number of nodes involved.