Cancer Staging Manual

The AJCC has created a set of desk reference resource materials designed to provide in-depth, easy-to-access information for doctors and other medical professionals staging cancer patients, and for cancer registrars abstracting cancer cases.

Supplementary Materials | AJCC Cancer Staging Manual, 8th Edition

Background

 
As part of the 8th Edition Project, authors were asked to develop content regarding three topics in cancer staging: 
  • Emerging Prognostic Factors for Clinical Care
  • Risk Assessment Models
  • Recommendations for Clinical Trial Stratification
Because of the rapidly-evolving nature of these topics, AJCC did not want to limit this information to the print manual where it would remain static for the life of the edition.  These topics are provided here, with the plan to update this information on a regular basis as the literature evolves.  Some of this information is incomplete, but it serves as a starting point for further study.
 
 

Emerging Prognostic Factors for Clinical Care

  
The Emerging Prognostic Factors for Clinical Care section describes factors for which there is not a widespread significant evidence base.  Some institutional and national databases abstract data on these variables. These factors should be re-evaluated in the coming years as the evidence base grows.
 

Risk Assessment Models

  
The AJCC has recently established guidelines that will be used to evaluate published statistical prediction models for the purpose of granting endorsement for clinical use.  Although this is a monumental step forward towards the goal of precision medicine, this work was only very recently published.  For this reason, the AJCC Precision Medicine Core (PMC) has evaluated only a small number of existing models that have been published or may be in clinical use for certain disease sites (listed below). In the future, the statistical prediction models for more cancer sites will be evaluated, and those that meet all AJCC criteria will be endorsed.  A full disclosure of all models evaluated by the PMC according to the aforementioned guidelines will be published on this site and regularly updated at a frequency to be determined.
  • Colon and Rectum (Chapter 20)
  • Gastrointestinal Stromal Tumors (Chapter 43)
  • Soft Tissue Sarcoma of the Retroperitoneum (Chapter 44)
  • Melanoma (Chapter 47)
  • Breast (Chapter 48)
  • Prostate (Chapter 58)
  • Hodgkin and Non-Hodgkin Lymphomas (Chapter 79)
    • Diffuse Large B Cell Lymphoma 
    • Mantle Cell Lymphoma 
    • Marginal Zone Lymphoma
    • Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
    • Peripheral T-Cell Lymphoma 
    • Hodgkin Lymphoma
  • Leukemia (Chapter 83)
    • Acute Lymphoblastic Leukemia in Children
    • Acute Lymphocytic Leukemia in Adults
    • Chronic Myeloid Leukemia
 

Recommendations for Clinical Trial Stratification

The goal of this section is to guide those entities – whether academic or commercial – that are designing clinical trials as to the most important prognostic factors of a given disease that should be built into  the stratification criteria for the clinical trial.  Cooperative group trials for decades have included stratification factors based upon prognostic features.  The AJCC wants to support clinical trial development by specifically calling these factors out as issues to consider in specific disease areas.  AJCC encourages Expert Panels to develop an evidence based menu of stratification factors as a guide for clinical trial developers to use.

   

​​Head and Ne​​ck

Chapter

Disease​​

5.        

Staging Head and Neck Cancers

6.        

Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck​

7.        

Lip and Oral Cavity​

8.        

Major Salivary Glands​

9.        

Nasopharynx​

10.    

HPV-Mediated (p16+) Oropharyngeal Cancer​

11.    

Oropharynx (p16-) and Hypopharynx

12.    

Nasal Cavity and Paranasal Sinuses

13.    

Larynx

14.    

Mucosal Melanoma of the Head and Neck​

15.    

Cutaneous Squamous Cell Carcinoma of the Head and Neck​

 

 
 
 

Gastrointestinal ​ Tract

Chapter

Disease

16.        

Esophagus and Esophagogastric Junction

17.

Stomach​

18.        

Small Intestine

19.        

Appendix: Carcinoma​

20.        

Colon and Rectum​

21.    

Anus​

22.    

Liver​

23.   

Intrahepatic Bile Ducts​

24.    

Gallbladder​

25.    

Perihilar Bile Ducts

26.    

Distal Bile Duct

27.    

Ampulla Vater

28.    

Exocrine Pancreas

29.    

Neuroendocrine Tumors or the Stomach​

30.    

Neuroendocrine Tumors of the Duodenum and Ampulla of Vater​

31.    

Neuroendocrine Tumors of the Jejunum and Ileum 

32.    

Appendix NET Neuroendocrine Tumors of the Appendix

33.    

Neuroendocrine Tumors of the Colon and Rectum

34.    

Neuroendocrine Tumors of the Pancreas​

 

 
 
 

Thorax 

Chapter

Disease

35.

Thymus

36.      

Lung​

37.      

Malignant Pleural Mesothelioma

 

Bone and​ Soft Tissue Sarcoma

Chapter

Disease

38.

Bone

39.    

Introduction to Soft Tissue Sarcoma

40.

Soft Tissue Sarcoma of the Head and Neck​

41.    

Soft Tissue Sarcoma of the Trunk and Extremities​

42.    

Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs​

43.    

Gastrointestinal Stromal Tumor (GIST)

44.    

Soft Tissue Sarcoma of the Retroperitoneum

45.    

Soft Tissue Sarcoma - Unusual Histologies and Sites​

 

Skin

Chapter

Disease

46 

Merkel Cell Carcinoma​

47.    

Melanoma of the Skin​

 

​Breast

Chapter

Disease

48.    

Breast

 

Female Reproductive Organs

Chapter

Disease

49.    

Introduction to Female Reproductive Organs

50.    

Vulva​

51.    

Vagina

52.    

Cervi​x Uteri​ 

53.    

Corpus Uteri - Carcinoma and Carcinosarcoma​ 

54.    

Corpus Uteri – Sarcoma

55.    

Ovary, Fallopian Tube, and Primary Peritoneal Carcinoma​

56.    

Gestational Trophoblastic Neoplasms​

 

Genito​​urinary System

Chapter

Disease

57.    

Penis​

58.    

Prostate​

59.    

Testis​

60.    

Kidney​

61.    

Renal Pelvis and Ureter​

62.    

Urinary Bladder​

63.    

Urethra

 

Ophthalmic Sites

Chapter

Disease

64.    

Eyelid Carcinoma​

65.    

Conjunctival Carcinoma​

66.    

Conjunctival Melanoma​

67.    

Uveal Melanoma

68.    

Retinoblastoma

69.    

Lacrimal Gland Carcinoma 

70.    

Orbital Sarcoma

71.    

Ocular Adnexal Lymphoma

 

Central Nervous System

Chapter

Disease

72.    

Brain and Spinal Cord

 

End​ocrine System

Chapter

Disease

73.    

Thyroid - Differentiated and Anaplastic

74.    

Thyroid - Medullary

75.    

Parathyroid

76.    

Adrenal Cortical Carcinoma

77.    

Adrenal - Neuroendocrine Tumors​

 

​Hematologic Malignancies

Chapter

Disease

78.    

Introduction to Hematologic Malignancies

79.    

Hodgkin and Non-Hodgkin Lymphomas

80.    

Pediatric Hodgkin and Non-Hodgkin Lymphomas

81.    

Primary Cutaneous Lymphomas

82.    

Plasma Cell Myeloma and Plasma Cell Disorders​

83.    

Leukemia

 

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