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The new (Version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer.

Literature Information

DOI	10.3322/caac.21663
PMID	33784415
Journal	CA: a cancer journal for clinicians
Impact Factor	232.4
JCR Quartile	Q1
Publication Year	2021
Times Cited	94
Keywords	American Joint Committee on Cancer (AJCC), cervix, staging, version 9
Literature Type	Journal Article
ISSN	0007-9235
Pages	287-298
Issue	71(4)
Authors	Alexander B Olawaiye, Thomas P Baker, M Kay Washington, David G Mutch

TL;DR

The article discusses the updates to the AJCC TNM staging for cervical cancer as part of the forthcoming ninth edition of the staging manual, emphasizing significant changes such as the integration of imaging and surgical findings, the removal of lateral spread from T1a, and the introduction of a new subcategory T1b3. These revisions aim to enhance the accuracy of cervical cancer staging and align it with international standards, thereby improving clinical decision-making and patient outcomes.

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American Joint Committee on Cancer (AJCC) · cervix · staging · version 9

Abstract

The American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging for all cancer sites has been periodically updated as a published manual for many years. The last update, the eighth edition AJCC Cancer Staging Manual went into use on January 1, 2018. The AJCC has since restructured and updated its processes, and all AJCC staging-related data are now housed on its new application programming interface. Consequently, the next AJCC TNM staging update, AJCC version 9 TNM staging, will be published electronically and will be released chapter by chapter. The first chapter of version 9 AJCC TNM staging is the updated cervical cancer staging, which is now published. This article highlights the changes to the AJCC TNM cervical cancer staging; these changes align with the International Federation of Gynecology and Obstetrics staging. The most important of the changes are: 1) the incorporation of imaging and surgical findings, 2) the elimination of lateral spread from T1a, 3) the addition of a subcategory to T1b (T1b3), and 4) histopathology is updated to reflect human papillomavirus-associated and human papillomavirus-independent carcinomas.

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Primary Questions Addressed

1. How do the changes in the AJCC version 9 cervical cancer staging impact clinical practice and treatment planning?
2. What are the implications of incorporating imaging and surgical findings into the AJCC version 9 cervical cancer staging?
3. How does the new subcategory T1b3 in AJCC version 9 enhance the understanding of cervical cancer progression?
4. In what ways does the updated histopathology classification in AJCC version 9 affect the management of HPV-associated versus HPV-independent cervical carcinomas?
5. How do the changes in AJCC version 9 align with global standards in cancer staging, particularly with the International Federation of Gynecology and Obstetrics?

Key Findings

1. Research Background and Purpose: The American Joint Committee on Cancer (AJCC) has periodically updated its tumor, node, metastasis (TNM) staging system to reflect advancements in medical understanding and technology. The most recent edition prior to this was the eighth edition, which became effective on January 1, 2018. The purpose of the research presented in this article is to outline the updates and changes in the AJCC TNM staging for cervical cancer, specifically in the newly released version 9. This update aims to enhance the accuracy and applicability of cervical cancer staging in clinical practice, aligning it more closely with international standards set by the International Federation of Gynecology and Obstetrics (FIGO).

2. Main Methods and Findings: The article details several key changes in the cervical cancer staging system as part of the AJCC version 9 update. These changes include:

• The integration of imaging and surgical findings into the staging process, enhancing the precision of tumor classification.
• The removal of the criterion for lateral spread in the T1a category, simplifying the staging for early invasive cancers.
• The introduction of a new subcategory (T1b3) under T1b, which provides a more nuanced classification for tumors that meet specific criteria.
• An update to the histopathological categories to better differentiate between human papillomavirus (HPV)-associated and HPV-independent carcinomas, reflecting the evolving understanding of cervical cancer etiology.

3. Core Conclusions: The AJCC version 9 TNM staging system for cervical cancer represents a significant advancement in cancer staging by incorporating modern diagnostic techniques and refining classification criteria. These updates are intended to provide more accurate prognostic information and improve treatment planning for patients with cervical cancer. The alignment with FIGO staging principles enhances the global applicability of the AJCC guidelines, fostering consistency in cervical cancer management across different regions.

4. Research Significance and Impact: The updated AJCC TNM staging for cervical cancer is crucial for several reasons. Firstly, it enhances the specificity and accuracy of staging, which is vital for determining treatment strategies and predicting patient outcomes. Secondly, by incorporating modern imaging and surgical findings, the updates reflect the realities of current clinical practices, potentially leading to better patient-centered care. Thirdly, the distinction between HPV-associated and independent tumors could influence therapeutic approaches and clinical trials. Overall, the improvements in this staging system are expected to have a substantial impact on cervical cancer management and research, guiding future studies and interventions in the field.

Literatures Citing This Work

1. Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy. In regard to Vojtíšek et al. - Cem Onal;Guler Yavas;Cagdas Yavas - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] (2021)
2. Cancer of the cervix uteri: 2021 update. - Neerja Bhatla;Daisuke Aoki;Daya Nand Sharma;Rengaswamy Sankaranarayanan - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (2021)
3. Prognostic Value of Vascular-Expressed PSMA and CD248 in Urothelial Carcinoma of the Bladder. - Yu Li;Keying Zhang;Fa Yang;Dian Jiao;Mingyang Li;Xiaolong Zhao;Chao Xu;Shaojie Liu;Hongji Li;Shengjia Shi;Bo Yang;Lijun Yang;Donghui Han;Weihong Wen;Weijun Qin - Frontiers in oncology (2021)
4. The risk of distant metastases in patients with gynecologic cancers after surgery: a population-based study. - Yi-Hsuan Hsiao;Pei-Ni Chen;Min-Chien Hsin;Po-Hui Wang;Jing-Yang Huang;Shun-Fa Yang - Aging (2021)
5. FNDC3B and BPGM Are Involved in Human Papillomavirus-Mediated Carcinogenesis of Cervical Cancer. - Luhan Zhang;Hong Yu;Tian Deng;Li Ling;Juan Wen;Mingfen Lv;Rongying Ou;Qiaozhi Wang;Yunsheng Xu - Frontiers in oncology (2021)
6. HPV E6/E7 promotes aerobic glycolysis in cervical cancer by regulating IGF2BP2 to stabilize m6A-MYC expression. - Chenchen Hu;Tianyue Liu;Chenying Han;Yuxin Xuan;Dongbo Jiang;Yuanjie Sun;Xiyang Zhang;Wenxin Zhang;Yiming Xu;Yang Liu;Jingyu Pan;Jing Wang;Jiangjiang Fan;Yinggang Che;Yinan Huang;Jiaxing Zhang;Jiaqi Ding;Shuya Yang;Kun Yang - International journal of biological sciences (2022)
7. Stage IA1 HPV-associated cervical squamous cell carcinoma metastasizing to ovary by special pathway: a case report and literature review. - Yuanyuan Zhang;Xiaobo Zhang;Huan Wang;Danhua Shen - Journal of ovarian research (2022)
8. Prevalence of long-term opioid use after radiotherapy for cervical cancer in a Brazilian cancer center. - Lucas Zanetti de Albuquerque;Jesse Lopes da Silva;Alexssandra Lima Siqueira Dos Santos;Isabella Pereira Rodrigues;Andreia Cristina de Melo - Journal of cancer survivorship : research and practice (2023)
9. Management of Early-Stage Cervical Cancer: A Literature Review. - Yasmin Medeiros Guimarães;Luani Rezende Godoy;Adhemar Longatto-Filho;Ricardo Dos Reis - Cancers (2022)
10. Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. - Jyoti S Mayadev;Guihao Ke;Umesh Mahantshetty;Marcos David Pereira;Rafal Tarnawski;Takafumi Toita - International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (2022)

... (84 more literatures)

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