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8/11/2019 Staging Moments Head Neck 1

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AJCC Staging Moments

AJCC TNM Staging 7th Edition

Glottic Larynx Case #1

Contributors:Jatin P. Shah, MD Memorial Sloan-Kettering Cancer Center, New York, New YorkCarol R. Bradford, MD University of Michigan Medical Center, Ann Arbor, Michigan

James Brierley, MB Princess Margaret Hospital/University Health Network, Toronto, Ontario


2/22

Larynx Case # 1Presentation of New Case

Newly diagnosed larynx cancer patient

Presentation at Cancer Conference for treatmentrecommendations and clinical staging


3/22

Larynx Case # 1History & Physical

63 yr old female who presented with a raspyvoice, no palpable lymphadenopathy

No smoking hx

No family history of ca


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5/22

Larynx Case # 1Diagnostic Procedure

Procedure Biopsy left vocal cord during laryngoscopy with

operating microscope

Pathology Report Well differentiated squamous cell ca Grade 1

HPV status is negative


6/22

Larynx Case # 1Clinical Staging

Clinical staging Uses information from the physical exam, imaging,

and diagnostic biopsy

Purpose Select appropriate treatment Estimate prognosis


7/22


Synopsis- patient with small lesion on left vocalcord, clinically negative lymph nodes

What is the clinical stage? T____ N____

M____ Stage Group______


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Clinical Stage correct answer T1a N0 M0 Stage Group I

Based on stage and other factors, treatment isselected

Review NCCN treatment guidelines for this stage


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Prognostic FactorsClinically Significant

Applicable to this case

Human papillomavirus (HPV) status: neg

HPV is less prevalent in laryngeal cancer thanoropharyngeal cancers

There are no prognostic factors required forstaging


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12/22

Larynx Case # 1Presentation after Surgery

The choice of treatment lies between Definitive external beam radiotherapy Endoscopic laser resection Open partial laryngectomy

The procedure chosen based on patient factors and thelesion confined to one vocal cord and clinically negativenodes, Stage I, is partial laryngectomy

Presentation at Cancer Conference for adjuvanttreatment recommendations and pathologic staging


13/22

Larynx Case # 1Surgery & Findings

Procedure Partial laryngectomy

Operative findings No additional information


14/22

Larynx Case # 1Pathology Results

Squamous cell carcinoma, involving lt vocal cord Tumor size - 1.2cm Grade - moderately differentiated Maximal thickness - 0.7cm Invades lamina propria Extension to anterior commissure Margins negative 4 regional nodes negative


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Larynx Case # 1Pathologic 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)


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Synopsis- patient with 1.2cm lt vocal cord lesionextending to the anterior commissure, regionalnodes negative

What is the pathologic stage?(remember, clinical M may be used in pathologic staging)

T____

N____ M____ Stage Group______


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Pathologic Stage correct answer pT1a pN0 cM0 Stage Group I

Based on pathologic stage, there is moreinformation to estimate prognosis and forselection of adjuvant treatment.


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Rationale for staging choices pT1a for tumor limited to one vocal cord (may involve

anterior or posterior commissure) with normal mobility

pN0 because regional nodes were negative

cM0 - use clinical M with pathologic staging unlessthere is pathologic confirmation of distant metastases


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Prognostic FactorsClinically Significant

Applicable to this case

Size of lymph nodes: n/a

Extracapsular extension from lymph nodes: n/a

Lymph node levels involved: n/a

Extracapsular spread (ECS) pathologic: n/a

Human papillomavirus (HPV) status: neg

There are no prognostic factors required for staging


20/22

AJCC Cancer Staging AtlasT1 limited to vocal cord(s),

normal mobility

T1a one vocal cord

T1b both vocal cords


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Larynx Case # 1Recap of Staging

Summary of correct answers Clinical stage T1a N0 M0 Stage Group I Pathologic stage T1a N0 cM0 Stage Group I

The staging classifications have a different purposeand therefore can be different. Do not go back and

change the clinical staging based on pathologicstaging information.


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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 for selection of adjuvant treatment and prognosis Used to evaluate end-results (survival)

staging moments head neck 1

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