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.
Chapter 1
- Staging Rules
- Expansion of chapter 1 rules
- Explains the basics of staging
- Clarifies terminology
- Describes time frame and criteria for each classification
- Some new rules which are based on changes in medical practice
- Detailed rules for clinical and pathological classifications and for stage groups
- The rules are now in table format for easy reference
- Only managing physician may assign stage. Pathologist and radiologist may provide information but CANNOT assign a stage.
- Expansion of chapter 1 rules
Changes to Disease Site Chapters
- New and revised chapters
- Some chapters split
- 83 chapters (7th edition had 57)
- Organization of chapters by body system or function (Part I through Part XVIII)
- Thyroid moved to endocrine system
- GIST moved to soft tissue sarcoma
- Urinary tract in own section that includes both males and females
- New Features
- Levels of evidence
- Imaging
- Radiologists equal partner with pathologists and other physicians in helping stage patients
- Promotion among radiology group to provide structured reports similar to CAP reports for pathologists
- Risk Assessment Models
- Recommendations for Clinical Stratification
- Prognostic Factors
- Required for stage grouping
- Recommended for clinical care
- Emerging factors – only available online
- Registry data collection variable
- All are not required. Will be determined by various standard setters
- Histology code changes
- WHO classifications of tumors
- What pathologists use
- The staging is only for the histologies indicated in each chapter
- Discussions ongoing with SEER how this affects MPH rules
- The colon cancer histology needs to indicate the histology that is driving the prognosis, not the fact that is arose in a polyp
- None of the codes in colon chapter include those that arise in polyp
- WHO classifications of tumors
New and Changed Disease Site Chapters
- New Paradigms
- Separate stage groups for post neoadjuvant therapy staging
- Unknown primaries with nodal involvement
- Inclusion of staging for sites not in previous editions
- New disease site chapters
- Head and Neck
- Cervical lymph nodes and unknown primary
- All cases with cervical nodes positive and unknown primary will be staged with this chapter except:
- EBV-related stage with nasopharynx
- HPV-related stage with oropharynx
- All cases with cervical nodes positive and unknown primary will be staged with this chapter except:
- HPV-mediated oropharynx cancer
- Cutaneous squamous cell carcinoma of head and neck
- Cervical lymph nodes and unknown primary
- Thorax
- Thymus
- Endocrine System
- Parathyroid
- Adrenal neuroendocrine tumors
- Hematologic malignancies
- Leukemia
- Head and Neck
Changed Chapters
- Pancreas split into 2 chapters
- Exocrine pancreas in hepatobiliary system
- Neuroendocrine tumor of pancreas in neuroendocrine tumors
- Neuroendocrine tumor chapter has now been split into 6 different chapters
- Stomach
- Duodenum and ampulla of vater
- Jejunum and ileum
- Appendix
- Colon and rectum
- Pancreas
- Bone has multiple staging sections
- Appendicular skeleton/trunk/skull/face
- Pelvis
- Spine
- Soft tissue sarcoma split into separate chapters
- Head and neck
- Trunk and extremities
- Abdomen and thoracic visceral organs
- Retroperitoneum
- Unusual histologies and sites
- Head and Neck Pharynx now 3 separate chapters
- Nasopharynx
- HPV-mediated oropharynx p16+
- Oropharynx p16- and hypopharynx
- Appendix split into 2 chapters
- Appendix in lower GI tract chapter
- Neuroendocrine tumors of appendix in neuroendocrine tumor chapter
- Endocrine system thyroid now 2 chapters
- Thyroid – differentiated and anaplastic
- Thyroid – medullary
- Ovary, fallopian tube and primary peritoneal carcinoma merged into one chapter
- Cutaneous squamous cell carcinoma and other cutaneous carcinoma have been deleted