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Cancer staging evolves

OCTOBER 24, 2017
Clinical Congress Daily Highlights, Tuesday Second Edition

For four decades, the American Joint Committee on Cancer (AJCC) has published its Cancer Staging Manual, which serves as the gold standard for general surgeons, oncologists, and radiation oncologists in staging a wide variety of cancers.

A Tuesday session co-chaired by David Roland Byrd, MD, FACS, University of Washington, Seattle, WA, and AJCC Chairman; and David J. Winchester, MD, FACS, University of Chicago, Chicago, IL, highlighted updates to the 8th Edition of the AJCC Cancer Staging Manual, to be published in January 2018. The session touched on key updates to cancer staging protocols across a number of different cancers, including breast cancer, colorectal cancers (CRC), and melanoma.

“Cancer patients are taught as soon as they hear the word cancer, both in talking to others and in looking online, to ask, ‘What’s my stage?’ ” Dr. Byrd said.

Cancer staging indicates how much cancer is in a patient’s body, how aggressive it is and the extent to which it has spread. Knowing the stage helps an oncology team develop a prognosis and design a treatment plan.

It’s more important than ever for surgeons to be up to date with quickly evolving staging guidelines, particularly as precision medicine becomes more common. In breast cancer, for example, the emergence of important biomarkers like the estrogen and progesterone receptors and HER2 has influenced the guidelines.

“Breast cancer stage reflects tumor biology and/or appropriate therapy, but change is certain. It’s critical to all those in the room today and beyond that we continue to stage patients and help collect data to inform future critical changes,” Dr. Winchester said.

Staging is also evolving in malignancies like colorectal cancer (CRC) and melanoma, where genetic markers and new diagnostic tools are emerging.

“You’ve heard allusions to personalized medicine today, and this is what the AJCC is morphing into. Each of the chapters in the latest edition talk about what should be included in a personalized risk assessment model,” said panelist Frederick L. Greene, MD, FACS, and former Chairman of the AJCC.

Jeffrey E. Gershenwald, MD, FACS, MD Anderson Cancer Center, Houston, TX described the situation in melanoma.

“In the melanoma space in particular, we will be and already have been working to identify additional clinical and pathological markers for tool development.”

Cancer staging is complex science, with an increasing number of variables. But as the data mounts, it gives us greater opportunity provide patients with the most accurate prognosis and treatment strategy.

Additional Information:
The Panel Session, Evolving Concepts in the Eighth Edition American Joint Committee on Cancer (AJCC) Staging Manual Systems: Breast Cancer, Colorectal and Melanoma, was held October 24, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at

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