The AJCC held a webinar on the AJCC 8th edition recently. The 8th edition will take affect with cases diagnosed 1/1/18. The changes are many and are synopsized below. Careful review of each chapter prior to staging a case in the 8th edition is recommended. The Eighth Edition is dedicated to all Cancer Registrars.
- Staging Changes
- Head and Neck
- Cervical Node and Unknown Primary
- New criteria for extranodal extension
- Occult tumors are T0
- HPV-mediated Oropharynx cancer
- P16+ staged in this chapter
- P16- staged with oropharynx and hypopharynx chapter
- New chapter cutaneous squamous cell carcinoma of head and neck
- Does not change reportability rules
- Cervical Node and Unknown Primary
- Upper GI Tract
- Esophagus and esophagogastric junction & Stomach
- Different stage group tables for clinical, pathological and yPathological
- Change in proximal stomach location for EGJ tumors
- Esophagus and esophagogastric junction & Stomach
- Lower GI
- Colorectal
- Histology does not include polyp origin
- Anus
- Perianal staged with this chapter
- Anatomical illustrations for perianal vs skin
- Colorectal
- Neuroendocrine Tumors
- Well differentiated is not the grade
- Grade based on mitotic count and Ki-67 index
- Thorax
- Lung
- New designations to specify type of in situ
- New size points
- New T1mi
- Tables with criteria for multiple tumors vs separate tumor
- Revisions and new M1 subcategories
- Lung
- Bone and Soft Tissue Sarcoma
- Bone
- T category by type of bone
- Grade must be assigned according to AJCC grade table
- Soft tissue
- Separate chapters based on site and/or histology
- GIST in this section
- Bone
- Skin
- Merkel cell carcinoma
- Rule change for cN category
- Need to indicate sentinel lymph nodes only
- Different stage groups for clinical and pathological
- Melanoma
- New size points for T category
- Mitotic rate no longer used
- Redesigned stage tables
- Different stage groups for clinical and pathological
- Merkel cell carcinoma
- Breast
- Two different stage group tables – anatomic and prognostic
- Anatomic Stage Group table only used in regions where biomarker tests are not routinely available
- Prognostic Stage Group table must be used in countries where biomarker tests routinely performed even if not performed for the particular patient or case
- Cancer registries must use Prognostic Stage Group tables
- Cannot mix and match Anatomic and Prognostic Stage Groups
- If biomarkers not available case reported as unstaged
- TNM information assigned but registry stage group is 99
- Lobular carcinoma in situ is NOT staged by AJCC
- AJCC considers LCIS a benign entity
- Does not affect reportability – decision per standard setters
- Prostate
- Grade Group
- WHO and ISUP formalized changes to Gleason scoring
- No pT2 subcategories
- Grade Group
- Thyroid
- Differentiated new age cut point <55 (previously 45)
- Anaplastic New T categories
- Hematologic Malignancies
- Lymphoma will no longer use Ann Arbor and will use Lugano
- SLL/CLL will use Lugano AND Rai
- Plasma Cell Myeloma will use RISS staging
- Prognostic factors required for clinical care for Leukemia
- Head and Neck