AJCC CANCER STAGING MANUAL, TH HOWDIDTHEY DO THAT? Cancer... · • The AJCC Cancer Staging Manual, 8th Edition: Continuing to build a bridge from a “population‐based” to a

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A J C C C A N C E R S TA G I N G MA N UA L , 8 T H E D I T I O N

NOVEMBER 5, 2018CHARLESTON, SC

HOW DID THEY DO THAT?

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1. About the MANUAL – not about stage

2. Short History

3. People and Teams

4. Manual Organization

5. Overall and Universal Changes

6. What’s next


Introduction

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1Short History of the AJCC and TNM Stage

S E C T I O N 1

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S H O R T H I S T O R Y

1959 AJC is formed 1977 Edition 11980 AJC

become AJCC1983 2nd

Edition1988 3rd

Edition

1990’s AJCC TNM is Standard

AJC is formed – American Joint Committee for Cancer Staging and End‐Results Reporting

AJC becomes the AJCC – American Joint Committee on Cancer

3rd Edition is published 5 years later.

AJC Cancer Staging Manual is published.

AJCC Cancer Staging Manual, 2nd

Edition is published. 6 yearsIn 1991, ACS/CoC required TNM Stage

on all sites. In 1995, CoC required TNM Stage form to be completed & signed

by the attending physician in the patient medical record. Per Vicki

Chiappata and Donna Gress

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S H O R T H I S T O R Y

1992 – 4th Edition1997 – 5th Edition

2002 – 6th Edition



Published

8th Edition Effective Date 1/1/2018

Four years after the publication of the 3rd Edition, the 4th Edition is published.

And another 5 years later, here comes the 6th Edition.

In 2016, the 8th Edition was published.

Five years later, the 5th Edition is released.

It took 8 years between the 6th and 7th

Editions as stage is becoming more complex.

Initially slated to be come effective in 2017, the effective date was delayed to 1/1/2018 to allow the cancer registry

community more time to prepare.

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2S E C T I O N 2

The People and the Teams of AJCC, 8th

Edition

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UICC AJCC

I N T E R N A T I O N A L C O L L A B O R A T I O N UICC

Union for International Cancer Control

1000+ members

163 countries represented

48 partner organizations

AJCC

United State and Canada

33 members represented

22 member organizations

Including NCRA, NAACCR, NCI/SEER, CDC/NPCR

Source: AJCC Cancer Staging Manual, 8th edition; www,uicc.org; cancerstaging.org

TNM Stage

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Core TeamsAJCC Editorial Board & Staff

16 Volunteers

6 Staff

Content Harmonization

Evidence Based Medicine & Statistics

Precision Medicine

Imaging

Data Collection (9 CTRs)

Expert Panels

18 Expert Panels

T E A M S

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Volunteers

550+ volunteers

Many serving multiple roles

Measurable Volunteer Hours

10/1/14 – 9/20/16: 5102 volunteer hours, includes only meeting time

Unknown hours: literature reviews and searches

special projects and reports

research

writing, reading, editing time

P E O P L E B Y T H E N U M B E R S

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3S E C T I O N 3

The Manual’s Organization

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“WHICH PRINTING DO I HAVE?”

“HOW CAN I TELL IF I HAVE THE 3RD PRINTING?”

Check the Editorial Page for that information – Page 7

Source: AJCC cancer Staging Manual, 8th Edition

T H E B O O K L O O K

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EIGHTH EDITION



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PREFACE• The AJCC Cancer Staging Manual, 8th Edition: Continuing to build a bridge from a

“population‐based” to a more “personalized” approach.

INTRODUCTION AND HISTORICAL OVERVIEW



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PART 1: General Information on Cancer Staging and End‐Results

Chapter 1: Principles of Cancer Staging

Chapter 2: Organization of the AJCC Cancer Staging Manual

Chapter 3: Cancer Survival Analysis

Chapter 4: Risk Models for Individualized Prognosis in the Practice of Precision Medicine



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Part II – XVIII Each Part covers a Body System

• Expert Panels • 10/18 panels had CTR representation (55.56%)

• Chapters – site or disease specific• Chapter Authors• Similar look chapter to chapter• Staging forms are NOT included

• AJCC Cancer Staging Form Supplement• https://cancerstaging.org/references‐

tools/deskreferences/Pages/Cancer‐Staging‐Forms.aspx



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CHAPTER FORMAT

• Chapter Summary• Cancers that are staged AND not staged by that chapter• Changes from 7th Edition to the 8th Edition• Topography and Morphology Codes included in that Chapter

• Introduction



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CHAPTER FORMAT

• Anatomy

• Rules for Classification



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CHAPTER FORMAT

• Prognostic Factors

• Risk Assessment Models



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CHAPTER FORMAT• Definitions for AJCC TNM

• AJCC Prognostic Stage Groups

• Registry Data Collection Variable

• Histologic Grade

• Histological Type



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CHAPTER FORMAT

• Survival Data (sometimes)

• Illustrations (sometimes)

• Bibliography



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4S E C T I O N 4

Overall and Universal Changes

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• Chapter Harmonization

• Prognostic Factors Included

• Post Neoadjuvant Stage in included

• Imaging Role Expanded

• Art / Photos – no more Atlas needed

O V E R A L L A N D U N I V E R S A L C H A N G E S

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• Chapter One• Please reprint Chapter 1 from the AJCC Website for 1st & 2nd printings only• There have been changes/clarification to the General Rules

• The Breast Chapter• Rewrite of the Breast Chapter done• Please reprint Chapter 48 from the AJCC Website for 1st & 2nd printings only• Multigene Panels, Genomic Profiles, etc

• Medical evidence • OncoTypeDx• Controversy

• Internal and External• Other products available

• Medical evidence sunrising


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• The Breast Chapter, cont.• Prognostic Stage Tables

• Highly complex• Initially some misses that revealed themselves• Tables were revised and corrected

• Anatomic vs. Prognostic Stage Tables• International staging and patient care issue• Medical Deprived and Economically Deprived Countries• Medical Appropriate and Medically Advanced Countries

• No Stage Grouping available for post neo‐adjuvant T N M


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• Staging Forms no longer included• Documentation on forms not required• Documentation “anywhere” in patient record• EHR have “built‐in” forms available• Available in the staging form supplement

• Errata• 1st and 2nd printings share an errata• 3rd printing has a separate errata• Updates will be available for Kindle Version for critical revisions


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5S E C T I O N 5

The Editorial Process

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E D I T O R I A L P R O C E S S

Authors Expert Panels Editorial Board Back and Forth Staff Publisher

Team of authors wrote and did the first run through of editing their sections.

Editorial Board read and made recommendations to authors.

AJCC Staff was also able to read and participate in the editorial process.

Expert Panel members read and had a chance to provide editorial

suggestions.

This process went back and forth, sometimes multiple times.

Publisher also had influence on the final outcome of the maual.

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6What’s Next

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eBook Version

Built on the Kindle Platform

Kindle Compatible Devices

Kindle app available for FREE download for Mac, PC’s, Android and Apple Phones

Available from Kindle, Amazon, COC website

List $99.99

Access on multiple devices with same user name and password –magic of syncing

N E W E S T P R O D U C T

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eBook Version

Same look and set‐up of hard copy manual

All errata to date of publication are included

Updates will be available for Kindle Version for critical revisions

Features

Table of Contents – click and forward

Bookmarks, Notes > Notebooks

Flashcards > Decks

N E W E S T P R O D U C T

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Staging Calculator

to be announced

Caution: Staging calculator are available in the electronic market

Licensed Users vs Unlicensed Users

Verify Verify VerifySingle Source of Truth

F U T U R E P L A N S

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T H E E L E P H A N T I N T H E R O O MC O U R T E S Y O F P I N T E R E S T

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Mistakes were made

Lessons have been learned

Silos need deconstructing

M I S T A K E S / L E S S E N S

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2. Short History

3. People and Teams

4. Manual Organization

5. Overall and Universal Changes

6. What’s next and ELEPHANTS

Conclusion

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Our data has the

power and strength to save

these children’s

lives.

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QUESTIONS????

[email protected] ‐939‐9362

Thank you

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Documents

AJCC CANCER STAGING MANUAL, TH HOWDIDTHEY DO THAT? Cancer... · • The AJCC Cancer Staging Manual, 8th Edition: Continuing to build a bridge from a “population‐based” to a