E so pha g us Sto ma c h 4/ 2/ 15 Collecting Cancer Data: - - PDF document

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E so pha g us Sto ma c h 4/ 2/ 15 Collecting Cancer Data: Esophagus & Stomach 2014-2015 NAACCR We b ina r Se rie s April 2, 2015 Q&A Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r c o nte nt thro ug h the Q&A

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SLIDE 1

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 1

Collecting Cancer Data: Esophagus & Stomach

2014-2015 NAACCR We b ina r Se rie s April 2, 2015

Q&A

  • Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r

c o nte nt thro ug h the Q&A pa ne l. Re minde r:

  • I

f yo u ha ve pa rtic ipa nts wa tc hing this we b ina r a t yo ur site , ple a se c o lle c t the ir na me s a nd e ma ils.

  • We will b e distrib uting a Q&A do c ume nt in a b o ut o ne we e k.

T his do c ume nt will fully a nswe r q ue stio ns a ske d during the we b ina r a nd will c o nta in a ny c o rre c tio ns tha t we ma y disc o ve r a fte r the we b ina r.

2

F ABUL OUS PRIZE S

3

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SLIDE 2

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 2

KE Y ST AT IST ICS: E SOPHAGUS

E ST IMAT E D NE W CASE S AND DE AT HS

  • Ne w c a se s: 16,980
  • 13,570 in me n
  • 3,410 in wo me n
  • De a ths: 15,590
  • 12,600 in me n
  • 2,990 in wo me n

SURVIVAL

Ame ric an Canc e r S

  • c ie ty

Canc e r F ac ts and F igure s 2015

Sta g e 5- Ye a r Re la tive Surviva l Ra te L

  • c a lize d

40% Re g io na l 21% Dista nt 4% Na tio na l Ca nc e r I nstitute ’ s Surve illa nc e , E pide mio lo g y, a nd E nd Re sults (SE E R)

KE Y ST AT IST ICS- ST OMACH

E ST IMAT E D NE W CASE S AND DE AT HS

  • Ne w c a se s: 24,590
  • 15,540 in me n
  • 9,050 in wo me n
  • De a ths: 10,720
  • 6,500 in me n
  • 4,220 in wo me n

SURVIVAL

Sta g e

5 ye a r

  • b se rve d

surviva l Sta g e IA 71% Sta g e IB 57% Sta g e I I A 46% Sta g e I I B 33% Sta g e I I I A 20% Sta g e I I I B 14% Sta g e I I I C 9% Sta g e IV 4%

Na tio na l Ca nc e r I nstitute ’ s SE E R da ta b a se Ame ric an Canc e r S

  • c ie ty

Canc e r F ac ts and F igure s 2015

HIST OL OGY

  • Sq ua mo us Ce ll

Ca rc ino ma

  • T

ypic a lly fo und in the uppe r two thirds o f the e so pha g us.

  • Ade no c a rc ino ma
  • Usua lly fo rms in the lo we r

third o f the e so pha g us, ne a r the sto ma c h.

Z-L ine

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SLIDE 3

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 3

  • Re pe a te d e xpo sure to

a c idic sto ma c h c o nte nts wa shing b a c k (re fluxing ) thro ug h the lo we r e so pha g e a l sphinc te r ma y c a use sq ua mo us c e lls to b e re pla c e d b y g la ndula r c e lls re se mb ling tho se c e lls in the sto ma c h.

Z-L ine

BARRE T T ’S E SOPHAGUS HIGH GRADE DYSPL ASIA/ CA IN SIT U

PE R AJCC MANUAL

  • Hig h g ra de dyspla sia

inc lude s a ll no n inva sive ne o pla stic e pithe lia fo rma lly c a lle d c a rc ino ma in situ.

  • Ca rc ino ma in situ no lo ng e r

use d fo r c o lumna r muc o sa e a nywhe re in the dig e stive tra c t.

PE R ST ANDARD SE T T E RS

  • Ple a se disc uss this issue with yo ur

c a nc e r c o mmitte e a nd/ o r pa tho lo g ists.

  • I

f the y fe e l the se c a se s sho uld b e re po rte d a s c a rc ino ma in situ, ple a se do so .

  • I

f the y do no t fe e l the se c a se s sho uld b e pic ke d up a s c a rc ino ma in situ, do no t re po rt the m to SE E R, Co C, o r yo ur sta te re g istry .

PROXIMAL

  • VS. DIST

AL

  • Pro xima l- T
  • wa rds the

inc iso rs

  • Dista l-Awa y fro m the

inc iso rs

  • T

his is the sa me fo r the e ntire GI tra c t

Pro xima l Dista l

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SLIDE 4

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 4

E SOPHAGUS OVE RVIE W

  • Ana to my

C15.3 C15.4 C15.5 C16.0 C16.0 C15.2 C15.1 C15.1 C15.0 (Ab do mina l e so pha g us)

10

18

T OPOGRAPHY: ST OMACH

  • Ca rdia (C16.0)
  • F

undus (C16.1)

  • Bo dy (C16.2)
  • Ga stric (Pylo ric ) Antrum

(C16.3)

  • Pylo rus (C16.4)
  • L

e sse r Curva ture (C16.5)

  • No t c la ssifia b le to C16.0 to

C16.4

  • Gre a te r Curva ture (C16.6)
  • No t c la ssifia b le to C16.0 to

C16.4

  • Sto ma c h NOS (C16.9)

Cardia

CS SCHE MA E SOPHAGUS

  • If the e pic e nte r o f tumo r

is in the dista l e so pha g us

a nd the c a rdia is invo lve d

use the E so pha g us Sc he ma a nd the AJCC c ha pte r fo r E so pha g us

Ca rdia

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SLIDE 5

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 5

CS SCHE MA E SOPHAGUSGE JUNCT ION

  • If the e pic e nte r o f a

tumo r is in the E GJ o r in the pro xima l 5c m o f the sto ma c h a nd the c a rdia is invo lve d use the E so phagusGE J unc tio n Sc he ma a nd the AJCC c ha pte r fo r e so pha g us.

Ca rdia

  • T

umo r is within 5c m o f the c a rdia a nd the c a rdia is invo lve d.

  • Wha t is the prima ry site ?
  • C16.2 Bo dy o f Sto ma c h
  • Wha t CS sc he ma wo uld b e

use d to sta g e this c a se ?

  • E

so pha g usGE Junc tio n

Ca rdia

POP QUIZ POP QUIZ

T umo r lo c a te d in the fundus o f the sto ma c h mo re tha n 5c m fro m the c a rdia .

  • Wha t is the prima ry site ?
  • C16.1 F

undus o f Sto ma c h

  • Wha t CS sc he ma wo uld b e

use d to sta g e this c a se ?

  • Sto ma c h

Ca rdia

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SLIDE 6

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 6

L AYE RS OF T HE E SOPHAGE AL WAL L

  • Muc o sa
  • Surfa c e e pithe lium, la mina

pro pria , a nd musc ula ris muc o sa

  • Sub muc o sa
  • Co nne c tive tissue , b lo o d ve sse ls,

a nd g la nds

  • Musc ula ris (middle la ye r)
  • Stria te d a nd Smo o th musc le
  • Adve ntitia
  • Co nne c tive tissue tha t me rg e s

with c o nne c tive tissue o f surro unding struc ture s

  • No S

e ro sa

16

L AYE RS OF T HE ST OMACH WAL L

17

Se ro sa l Sub se ro sa l Musc ula r Sub muc o sa l Muc o sa l

I ma g e so urc e : SE E R T ra ining We b site

RUGAE

  • Rug a e a se rie s o f

ridg e s pro duc e d b y fo lding o f the wa ll o f a n o rg a n.

  • Allo ws the sto ma c h

e xpa nd whe n ne e de d.

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SLIDE 7

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 7

L INI T I S PL AST ICA

  • Spre a ds to the musc le s
  • f the sto ma c h wa ll

a nd ma ke s it thic ke r a nd mo re rig id.

L YMPHAT ICS OF T HE E SOPHAGUS

  • Dra ina g e is intra mura l a nd

lo ng itudina l

  • Co nc e ntra tio n o f lympha tic

c ha nne ls in the sub muc o sa a nd la mina pro pria

  • T

he a na to mic site o f the c a nc e r a nd the no de s to whic h the site dra ins ma y no t b e the sa me .

L YMPHAT ICS OF T HE ST OMACH

  • Gre a te r c urva ture
  • Gre a te r o me nta l
  • Pylo ric
  • Pa nc re a tic o duo de na l
  • Pa nc re a tic a nd Sple nic

Are a

  • Pe ripa nc re a tic
  • Sple nic
  • L

e sse r c urva ture

  • L

e sse r o me nta l

  • L

e ft g a stric

  • Ce lia c
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SLIDE 8

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 8

DIST ANT ME T AST ASIS: E SOPHAGUS

  • T

he mo st c o mmo n site s a re :

  • L

ive r

  • L

ung s

  • Ple ura

DIST ANT ME T AST ASIS: ST OMACH

  • T

he mo st c o mmo n site s a re :

  • L

ive r

  • Pe rito ne a l surfa c e
  • Dista nt lymph no de s

GRADE

  • F
  • r E

so pha g us a nd E GJ, g ra de is re q uire d to c a lc ula te AJCC sta g e s 0-I I A fo r b o th sq ua mo us c e ll c a rc ino ma a nd a de no c a rc ino ma

  • Gra de is no t re q uire d to de rive AJCC T

NM sta g e fo r Sto ma c h

  • Sta nda rd fo ur g ra de g ra ding syste m
  • We ll diffe re ntia te d
  • Mo de ra te ly diffe re ntia te d
  • Po o rly diffe re ntia te d
  • Undiffe re ntia te d

23

GRADE

  • C T

1a N0 M0 G1 Sta g e I A

  • T

re a tme nt o ptio ns inc lude

  • E

so pha g e c to my

  • E

ndo sc o pic muc o sa l re se c tio n

  • Othe r a b la tive te c hniq ue
  • C T

1a N0 M0 G2-3 Sta g e I B

  • E

so pha g e c to my

24

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SLIDE 9

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 9

ST AGING: E SOPHAGUS & ST OMACH

25

E SOPHAGUS & E SOPHAGOGAST RIC JUNCT ION (E GJ): CHAPT E R 10

AJCC Ca nc e r Sta g e

26

AJCC CANCE R ST AGE : E SOPHAGUS & E GJ

  • I

CD-O-3 T

  • po g ra phy Co de s
  • C15.0-C15.5, C15.8-C15.9 (e so pha g us)
  • C16.0 (E

GJ)

  • C16.1 (fundus o f sto ma c h, pro xima l 5 c m o nly)
  • C16.2 (b o dy o f sto ma c h, pro xima l 5 c m o nly)
  • I

CD-O-3 Histo lo g y Co de Ra ng e s

  • C15 o nly
  • 8000-8576, 8940-8950, 8980-8981
  • C16 o nly
  • 8000-8152. 8154-8231, 8243-8245, 8247-8248, 8250-8576,

8940-8950, 8980-8981

27

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SLIDE 10

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 10

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ CL ASSIF ICAT ION

  • Clinic a l sta g ing
  • E

vide nc e prio r to tre a tme nt

  • E

so pha g o sc o py with b io psy, e ndo sc o pic e so pha g e a l ultra so und (E US), E US dire c te d fine ne e dle a spira tio n (E US-F NA), CT , PE T / CT

  • Pa tho lo g ic sta g ing
  • E

vide nc e prio r to tre a tme nt plus e vide nc e a c q uire d during a nd fro m surg e ry pa rtic ula rly pa tho lo g ic e xa m o f surg ic a l spe c ime n

28

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ

  • T

Ca te g o ry

  • T

X: Prima ry tumo r c a nno t b e a sse sse d

  • T

0: No e vide nc e o f prima ry tumo r

  • T

is: Hig h-g ra de dyspla sia

  • T

1: Inva de s la mina pro pria , musc ula ris muc o sa e , o r sub muc o sa

  • T

1a : Inva de s la mina pro pria o r musc ula ris muc o sa e

  • T

1b : Inva de s sub muc o sa

29

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ

  • T

Ca te g o ry

  • T

2: Inva de s musc ula ris pro pria

  • T

3: Inva de s a dve ntitia

  • T

4: Inva de s a dja c e nt struc ture s

  • T

4a : Re se c ta b le tumo r inva ding ple ura , pe ric a rdium,

  • r dia phra g m
  • T

4b : Unre se c ta b le tumo r inva ding o the r a dja c e nt struc ture s, suc h a s a o rta , ve rte b ra l b o dy, tra c he a , e tc .

30

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SLIDE 11

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 11

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ

  • N Ca te g o ry:
  • NX: Re g io na l lymph no de s c a nno t b e a sse sse d
  • N0: No re g io na l lymph no de me ta sta sis
  • N1: Me ta sta sis in 1-2 re g io na l lymph no de s
  • N2: Me ta sta sis in 3-6 re g io na l lymph no de s
  • N3: Me ta sta sis in 7 o r mo re re g io na l lymph no de s

31

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ

  • M Ca te g o ry
  • M0: No dista nt me ta sta sis
  • M1: Dista nt me ta sta sis

32

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ SQUAMOUS CE L L CARCINOMA

Sta g e T N M Gra de T umor L

  • c a tion

T is N0 M0 1, X Any I A T 1 N0 M0 1, X Any I B T 1 T 2-3 N0 N0 M0 M0 2-3 1, X Any L

  • we r, X

I I A T 2-3 T 2-3 N0 N0 M0 M0 1, X 2-3 Uppe r, middle L

  • we r, X

I I B T 2-3 T 1-2 N0 N1 M0 M0 2-3 Any Uppe r, middle Any

33

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SLIDE 12

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 12

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ SQUAMOUS CE L L CARCINOMA

Sta g e T N M Gra de T umor L

  • c a tion

I I I A T 1-2 T 3 T 4a N2 N1 N0 M0 M0 M0 Any Any Any Any Any Any I I I B T 3 N2 M0 Any Any I I I C T 4a T 4b Any N1-2 Any N3 M0 M0 M0 Any Any Any Any Any Any I V Any Any M1 Any Any

34

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ ADE NOCARCINOMA

Sta g e T N M Gra de

T is N0 M0 1, X I A T 1 N0 M0 1-2, X I B T 1 T 2 N0 N0 M0 M0 3 1-2, X I I A T 2 N0 M0 3 I I B T 3 T 1-2 N0 N0 M0 M0 Any Any

35

AJCC CANCE R ST AGE : E SOPHAGUS/ EGJ ADE NOCARCINOMA

Sta g e T N M Gra de

I I I A T 1-2 T 3 T 4a N2 N1 N0 M0 M0 M0 Any Any Any I I I I B T 3 N2 M0 Any I I I C T 4a T 4b Any N1-2 Any N3 M0 M0 M0 Any Any Any I V Any Any M1 Any

36

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SLIDE 13

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 13

POP QUIZ

  • CT

sc a n c he st/ a b do me n: Slig ht thic ke ning o f wa ll

  • f lo we r tho ra c ic e so pha g us.
  • E

GD with b io psy: Sma ll le sio n o f lo we r tho ra c ic e so pha g us, we ll diffe re ntia te d a de no c a rc ino ma ; no o the r a b no rma litie s

  • E

ndo sc o pic ultra so und (E US): L e sio n o f wa ll o f lo we r tho ra c ic e so pha g us inva de s la mina pro pria ; no lympha de no pa thy

  • E

so pha g o sc o py with e ndo muc o sa l re se c tio n: 1 c m we ll diffe re ntia te d a de no c a rc ino ma invo lving la mina pro pria

37

POP QUIZ

  • Wha t is the AJCC c linic a l sta g e ?
  • T

1a N0 M0 G1 Sta g e IA

  • Wha t is the AJCC pa tho lo g ic sta g e ?
  • T

1a NX M b la nk G1 Sta g e 99

38

E SOPHAGUS C15.0- C15.5, C15.8- C15.9

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

39

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SLIDE 14

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 14

SUMMARY ST AGE 2000: E SOPHAGUS

  • 0 I

n situ

  • No ninva sive ; intra e pithe lia l
  • 1 L
  • c a lize d o nly
  • Inva sive tumo r c o nfine d to :
  • I

ntra muc o sa NOS; la mina pro pria ; muc o sa NOS; musc ula ris muc o sa e ; musc ula ris pro pria inva de d; sub muc o sa

  • L
  • c a lize d NOS

40

SUMMARY ST AGE 2000: E SOPHAGUS

  • 2 Re g io na l b y dire c t e xte nsio n o nly
  • Adve ntitia a nd/ o r so ft tissue inva de d
  • E

so pha g us de sc rib e d a s “F IXE D”

41

SUMMARY ST AGE 2000: E SOPHAGUS

  • 2 Re g io na l b y dire c t e xte nsio n o nly
  • E

xte nsio n to :

  • Ce rvic a l e so pha g us (inc luding 1st 18 c m o f uppe r

e so pha g us)

  • Blo o d ve sse l(s) ma jo r: c a ro tid a rte ry, jug ula r ve in,

sub c la via n a rte ry; c a rina ; c e rvic a l ve rte b ra (e ); hypo pha rynx; la rynx; tra c he a ; thyro id g la nd

  • I

ntra tho ra c ic

  • L

ung via b ro nc hus; me dia stina l struc ture (s); ple ura ; rib (s); tho ra c ic ve rte b ra (e )

42

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SLIDE 15

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 15

SUMMARY ST AGE 2000: E SOPHAGUS

  • 2 Re g io na l b y dire c t e xte nsio n o nly
  • E

xte nsio n to :

  • I

ntra tho ra c ic , uppe r o r mid-po rtio n, e so pha g us

  • Blo o d ve sse l(s) ma jo r: a o rta , a zyg o s ve in, pulmo na ry

a rte ry/ ve in, ve na c a va ; c a rina ; dia phra g m; ma in ste m b ro nc hus; tra c he a

  • I

ntra tho ra c ic , lo we r po rtio n (a b do mina l), e so pha g us

  • Blo o d ve sse l(s) ma jo r: a o rta , g a stric a rte ry/ ve in, ve na

c a va ; dia phra g m; sto ma c h, c a rdia (via se ro sa )

43

SUMMARY ST AGE 2000: E SOPHAGUS

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Ce rvic a l o nly
  • Ce rvic a l NOS
  • Ante rio r de e p c e rvic a l (la te ro tra c he a l) (re c urre nt

la ryng e a l)

  • I

nte rna l jug ula r NOS:

  • De e p c e rvic a l NOS:
  • Uppe r NOS:
  • Jug ulo dig a stric (sub dig a stric )
  • Pe ri-/ pa ra e so pha g e a l
  • Sc a le ne (infe rio r de e p c e rvic a l)
  • Supra c la vic ula r (tra nsve rse c e rvic a l)

44

SUMMARY ST AGE 2000: E SOPHAGUS

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Intra tho ra c ic , uppe r tho ra c ic o r middle , o nly:
  • I

nte rna l jug ula r NOS:

  • De e p c e rvic a l NOS:
  • L
  • we r NOS:
  • Jug ulo -o mo hyo id (supra o mo hyo id)
  • Middle
  • Uppe r NOS:
  • Jug ulo dig a stric (sub dig a stric )

45

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SLIDE 16

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 16

SUMMARY ST AGE 2000: E SOPHAGUS

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Intra tho ra c ic , uppe r tho ra c ic o r middle , o nly:
  • I

ntra b ro nc hia l:

  • Ca rina l (tra c he o b ro nc hia l) (tra c he a l b ifurc a tio n)
  • Hila r (b ro nc ho pulmo na ry) (pro xima l lo b a r) (pulmo na ry

ro o t)

  • Pe ritra c he a l

46

SUMMARY ST AGE 2000: E SOPHAGUS

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Intra tho ra c ic , uppe r tho ra c ic o r middle , o nly:
  • L

e ft g a stric (supe rio r g a stric ):

  • Ca rdia c (c a rdia l)
  • L

e sse r c urva ture

  • Pe rig a stric , NOS
  • Pe ri-/ pa ra e so pha g e a l
  • Po ste rio r me dia stina l (tra c he o e so pha g e a l)
  • Supe rio r me dia stina l

47

SUMMARY ST AGE 2000: E SOPHAGUS

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Intra tho ra c ic , lo we r (a b do mina l), o nly:
  • L

e ft g a stric (supe rio r g a stric ):

  • Ca rdia c (c a rdia l)
  • L

e sse r c urva ture

  • Pe rig a stric , NOS
  • Pe ri-/ pa ra e so pha g e a l
  • Po ste rio r me dia stina l (tra c he o e so pha g e a l)
  • Re g io na l lymph no de (s) NOS

48

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SLIDE 17

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 17

SUMMARY ST AGE 2000: E SOPHAGUS

  • 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

  • Co de s 2 + 3
  • 5 Re g io na l NOS

49

SUMMARY ST AGE 2000: E SOPHAGUS

  • 7 Dista nt site (s)/ lymph no de (s) invo lve d
  • Adja c e nt struc ture s
  • Ce rvic a l/ uppe r e so pha g us:
  • L

ung

  • Ma in ste m b ro nc hus
  • Ple ura
  • T

ho ra c ic / middle e so pha g us:

  • Pe ric a rdium
  • Ab do mina l/ lo we r e so pha g us:
  • Dia phra g m fixe d

50

SUMMARY ST AGE 2000: E SOPHAGUS

  • 7 Dista nt site (s)/ lymph no de (s) invo lve d
  • Dista nt lymph no de (s):
  • Ce lia c fo r intra tho ra c ic e so pha g us
  • Ce rvic a l NOS fo r intra tho ra c ic e so pha g us
  • Pa ra -a o rtic fo r lo we r/ a b do mina l e so pha g us o nly
  • Sc a le ne (infe rio r de e p c e rvic a l) fo r intra tho ra c ic e so pha g us
  • nly
  • Supe rio r me dia stina l fo r c e rvic a l e so pha g us o nly
  • Supra c la vic ula r (tra nsve rse c e rvic a l no de ) fo r intra tho ra c ic
  • nly
  • Othe r dista nt lymph no de (s)

51

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 18

SUMMARY ST AGE 2000: E SOPHAGUS

  • 7 Dista nt site (s)/ lymph no de (s) invo lve d
  • F

urthe r c o ntig uo us e xte nsio n

  • Me ta sta sis
  • 9 Unkno wn if e xte nsio n o r me ta sta sis

52

POP QUIZ

  • CT

sc a n c he st/ a b do me n: L a rg e ma ss o f c e rvic a l e so pha g us with c e rvic a l a nd supe rio r me dia stina l lympha de no pa thy

  • E

GD with b io psy: Po o rly diffe re ntia te d sq ua mo us c e ll c a rc ino ma , c e rvic a l e so pha g us, invo lve s e so pha g e a l wa ll

  • E

ndo sc o pic ultra so und (E US): 5 c m le sio n o f c e rvic a l e so pha g us invo lve s a dve ntitia ; ma lig na nt c e rvic a l a nd supe rio r me dia stina l lymph no de s

  • T

re a te d with c he mo ra dia tio n.

53

POP QUIZ

  • Wha t is the c o de fo r Summa ry Sta g e 2000?

a . 0 In situ b . 1 L

  • c a lize d o nly

c . 2 Re g io na l b y dire c t e xte nsio n o nly

  • d. 3 Re g io na l lymph no de (s) invo lve d o nly

e . 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

f.

5 Re g io na l NOS

g . 7 Dista nt

  • h. 9 Unkno wn

54

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 19

COL L ABORAT IVE ST AGE DAT A COL L E CT ION SYST E M (CS) V0205

55

CS SCHE MAS

  • E

so pha g us

  • C15.0-C15.5, C15.8-C15.9
  • E

so pha g usGE Junc tio n

  • C16.0, C16.1, C16.2
  • Sto ma c h
  • C16.1-C16.6, C16.8-C16.9

56

SSF 1: CL INICAL ASSE SSME NT OF RE GIONAL L YMPH NODE S

  • Assig n the c o de tha t re fle c ts the numb e r o f

c linic a lly e vide nt re g io na l lymph no de s b a se d

  • n dia g no stic wo rkup
  • Physic a l e xa m, ima g ing , dia g no stic lymph no de

b io psy, e xplo ra to ry surg e ry witho ut re se c tio n

  • Co de 999
  • Use if the re is no dia g no stic wo rkup to a sse ss re g io na l lymph

no de s

57

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POP QUIZ

  • E

so pha g o sc o py with b io psy: 3 c m e so pha g e a l le sio n a t 18 c m, po o rly diffe re ntia te d sq ua mo us c e ll c a rc ino ma

  • E

ndo sc o pic Ultra so und (E US): L e sio n o f c e rvic a l e so pha g us inva de s tra c he a ; lympha de no pa thy o f c e rvic a l no de s

  • Physic ia n do c ume nte d sta g e : c T

4b c N2 c M0

  • Pa tie nt tre a te d with c he mo ra dia tio n

58

POP QUIZ

  • Wha t is the c o de fo r SSF

1?

  • 000: No de s no t c linic a lly e vide nt; ima g ing o f

re g io na l no de s pe rfo rme d a nd no de s no t me ntio ne d.

  • 200: Me ta sta sis in 3-6 re g io na l no de s, de te rmine d

c linic a lly; sta te d a s c linic a l N2

  • 400: Clinic a lly po sitive re g io na l no de s NOS
  • 999: Unkno wn

59

SSF 25 SCHE MA DISCRIMINAT OR: E SOPHAGUSGE JUNCT ION/ ST OMACH

  • De te rmine s the sc he ma to se le c t whe n prima ry

site is C16.1 o r C16.2

  • E
  • pha g usGE

Junc tio n OR Sto ma c h

  • Co de whe the r tumo r e xte nds to e so pha g us

c ro ssing E GJ a nd dista nc e o f tumo r midpo int fro m E GJ

  • Assig n c o de 981 if prima ry site is C16.3-C16.6,

C16.8, o r C16.9

  • Assig n c o de 982 if prima ry site is C16.0

60

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 21

ST OMACH: CHAPT E R 11

AJCC Ca nc e r Sta g e

61

AJCC CANCE R ST AGE : ST OMACH

  • I

CD-O-3 T

  • po g ra phy Co de s
  • C16.1*, C16.2*
  • C16.3-C16.6, C16.8-C16.9
  • I

CD-O-3 Histo lo g y Co de Ra ng e s

  • 8000-8152, 8154-8231, 8243-8245, 8247-8248, 8250-

8576, 8940-8950, 8980-8990

62

*T umo r mo re tha n 5 c m fro m E GJ

AJCC CANCE R ST AGE : ST OMACH

  • Clinic a l sta g ing
  • E

vide nc e prio r to tre a tme nt

  • Physic a l e xa m, ima g ing , e ndo sc o py, b io psy, & la b

finding s

63

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 22

AJCC CANCE R ST AGE : ST OMACH

  • Pa tho lo g ic sta g ing
  • E

vide nc e prio r to tre a tme nt plus finding s fro m surg ic a l e xplo ra tio n a nd e xa mina tio n o f pa tho lo g ic spe c ime n fro m re se c tio n

  • Re mo va l a nd histo lo g ic e xa m o f lymph no de s
  • T
  • ta l numb e r o f lymph no de s re mo ve d a nd numb e r po sitive fo r

me ta sta sis

  • Me ta sta tic no dule s in fa t a dja c e nt to prima ry tumo r

witho ut e vide nc e o f lymph no de c o nside re d re g io na l no de invo lve me nt

  • Me ta sta tic no dule s impla nte d o n pe rito ne a l surfa c e

c o nside re d dista nt me ta sta sis

64

AJCC CANCE R ST AGE : ST OMACH

  • T

Ca te g o ry

  • T

X: Prima ry tumo r c a nno t b e a sse sse d

  • T

0: No e vide nc e o f prima ry tumo r

  • T

is: Ca rc ino ma in situ: intra e pithe lia l tumo r witho ut inva sio n o f la mina pro pria

  • T

1: Inva de s la mina pro pria , musc ula ris muc o sa e , o r sub muc o sa

  • T

1a : Inva de s la mina pro pria o r musc ula ris muc o sa e

  • T

1b : Inva de s sub muc o sa

65

AJCC CANCE R ST AGE : ST OMACH

  • T

Ca te g o ry

  • T

2: Inva de s musc ula ris pro pria

  • T

3: Pe ne tra te s sub se ro sa l c o nne c tive tissue witho ut inva sio n o f visc e ra l pe rito ne um o r a dja c e nt struc ture s

  • T

4: Inva de s se ro sa (visc e ra l pe rito ne um) o r a dja c e nt struc ture s

  • T

4a : Inva de s se ro sa

  • T

4b : Inva de s a dja c e nt struc ture s

66

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 23

AJCC CANCE R ST AGE : ST OMACH

  • N Ca te g o ry:
  • NX: Re g io na l lymph no de s c a nno t b e a sse sse d
  • N0: No re g io na l lymph no de me ta sta sis
  • N1: Me ta sta sis in 1-2 re g io na l lymph no de s
  • N2: Me ta sta sis in 3-6 re g io na l lymph no de s
  • N3: Me ta sta sis in 7 o r mo re re g io na l lymph no de s
  • N3a : Me ta sta sis in 7-15 re g io na l lymph no de s
  • N3b : Me ta sta sis in 16 o r mo re re g io na l lymph no de s

67

AJCC CANCE R ST AGE : ST OMACH

  • M Ca te g o ry
  • M0: No dista nt me ta sta sis
  • M1: Dista nt me ta sta sis

68

AJCC CANCE R ST AGE : ST OMACH

Group T N M

Sta g e 0 T is N0 M0 Sta g e I A T 1 N0 M0 Sta g e I B T 2 T 1 N0 N1 M0 M0 Sta g e I I A T 3 T 2 T 1 N0 N1 N2 M0 M0 M0 Sta g e I I B T 4a T 3 T 2 T 1 N0 N1 N2 N3 M0 M0 M0 M0

69

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SLIDE 24

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 24

AJCC CANCE R ST AGE : ST OMACH

Group T N M

Sta g e I I I A T 4a T 3 T 2 N1 N2 N3 M0 M0 M0 Sta g e I I I B T 4b T 4b T 4a T 3 N0 N1 N2 N3 M0 M0 M0 M0 Sta g e I I I C T 4b T 4b T 4a N2 N3 N3 M0 M0 M0 Sta g e I V Any T Any N M1

70

POP QUIZ

  • Ab do mina l CT

sc a n: L a rg e ma ss o f g a stric a ntrum; no lympha de no pa thy; no live r le sio ns

  • Ga stro sc o py with b io psy: Mo de ra te ly

diffe re ntia te d a de no c a rc ino ma o f a ntrum

  • Ga stre c to my: 2 c m ma ss, mo de ra te ly

diffe re ntia te d a de no c a rc ino ma , o f a ntrum inva de s musc ula ris pro pria ; ma lig na nt no dule s

  • n se ro sa ; 0/ 16 lymph no de s with me ta sta sis

71

POP QUIZ

  • Wha t is the AJCC c linic a l sta g e ?
  • T

X N0 M0 Sta g e 99

  • Wha t is the AJCC pa tho lo g ic sta g e ?
  • T

2 N0 M1 Sta g e IV

72

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 25

ST OMACH C16.0- C16.6, C16.8- C16.9

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

73

SUMMARY ST AGE 2000: ST OMACH

  • 0 I

n situ

  • No ninva sive ; intra e pithe lia l
  • (Ade no )c a rc ino ma in a po lyp, no ninva sive
  • 1 L
  • c a lize d o nly
  • Inva sive tumo r c o nfine d to :
  • Intra muc o sa NOS; la mina pro pria ; muc o sa NOS; musc ula ris

muc o sa e ; musc ula ris pro pria ; pe rimusc ula r tissue inva de d; po lyp NOS: he a d o f po lyp, sta lk o f po lyp; sub muc o sa (supe rfic ia l inva sio n); sub se ro sa l tissue / fa t

  • E

xte nsio n thro ug h wa ll NOS

74

SUMMARY ST AGE 2000: ST OMACH

  • 1 L
  • c a lize d o nly
  • Impla nts inside sto ma c h
  • Intra lumina l spre a d (o nly) to e so pha g us o r

duo de num

  • Inva sio n thro ug h musc ula ris pro pria o r musc ula ris

NOS

  • L

initis pla stic a (diffuse invo lve me nt o f the e ntire sto ma c h wa ll)

  • L
  • c a lize d, NOS

75

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 26

SUMMARY ST AGE 2000: ST OMACH

  • 2 Re g io na l b y dire c t e xte nsio n o nly
  • E

xte nsio n to :

  • Adja c e nt tissue NOS
  • Co nne c tive tissue :
  • L

ig a me nts:

  • Ga stro c o lic
  • Ga stro he pa tic
  • Ga stro sple nic
  • Ome ntum NOS:
  • Gre a te r
  • L

e sse r

  • Pe rig a stric fa t

76

SUMMARY ST AGE 2000: ST OMACH

  • 2 Re g io na l b y dire c t e xte nsio n o nly
  • E

xte nsio n to :

  • Dia phra g m; duo de num via se ro sa o r NOS; e so pha g us via

se ro sa ; ile um; je junum; live r; pa nc re a s; sma ll inte stine NOS; sple e n; tra nsve rse c o lo n inc luding fle xure s

  • Inva sio n o f/ thro ug h:
  • Me so the lium; se ro sa ; tunic a se ro sa ; visc e ra l pe rito ne um

77

SUMMARY ST AGE 2000: ST OMACH

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Ce lia c
  • He pa tic
  • L

e ft g a stric (supe rio r g a stric ), NOS:

  • Ca rdia l
  • Ca rdio e so pha g e a l
  • Ga stric , le ft
  • Ga stro pa nc re a tic , le ft
  • L

e sse r c urva ture

  • L

e sse r o me ntum

  • Pa ra c a rdia l

78

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SLIDE 27

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 27

SUMMARY ST AGE 2000: ST OMACH

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Pa nc re a tic o sple nic (pa nc re a tic o lie na l)
  • Pe rig a stric , NOS
  • Pe ripa nc re a tic

79

SUMMARY ST AGE 2000: ST OMACH

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Rig ht g a stric (infe rio r g a stric ), NOS:
  • Ga stro c o lic
  • Ga stro duo de na l
  • Ga stro e piplo ic (g a stro -o me nta l), rig ht o r NOS
  • Ga stro he pa tic
  • Gre a te r c urva ture
  • Gre a te r o me nta l
  • I

nfra pylo ric

  • Pa nc re a tic o duo de na l
  • Pylo ric , NOS:
  • I

nfra pylo ric (sub pylo ric )

  • Supra pylo ric

80

SUMMARY ST AGE 2000: ST OMACH

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Sple nic (lie na l) NOS:
  • Ga stro e piplo ic (g a stro -o me nta l), le ft
  • Sple nic hila r
  • No dule (s) in pe rig a stric fa t
  • Re g io na l lymph no de (s), NOS

81

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SLIDE 28

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 28

SUMMARY ST AGE 2000: ST OMACH

  • 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

  • Co de s 2 + 3
  • 5 Re g io na l NOS

82

SUMMARY ST AGE 2000: ST OMACH

  • 7 Dista nt site (s)/ lymph no de (s) invo lve d
  • Dista nt lymph no de (s):
  • I

nfe rio r me se nte ric

  • Pa ra -a o rtic
  • Po rta he pa tis (po rta l) (hila r) [in hilus o f live r]
  • Re tro pe rito ne a l
  • Supe rio r me se nte ric
  • Othe r dista nt lymph no de (s)

83

SUMMARY ST AGE 2000: ST OMACH

  • 7 Dista nt site (s)/ lymph no de (s) invo lve d
  • E

xte nsio n to : Ab do mina l wa ll; a dre na l (supra re na l) g la nd; kidne y; re tro pe rito ne um

  • F

urthe r c o ntig uo us e xte nsio n

  • Me ta sta sis
  • 9 Unkno wn if e xte nsio n o r me ta sta sis

84

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SLIDE 29

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 29

POP QUIZ

  • Ab do mina l CT

sc a n: L a rg e ma ss o f g a stric a ntrum; no lympha de no pa thy; no live r le sio ns

  • Ga stro sc o py with b io psy: Mo de ra te ly

diffe re ntia te d a de no c a rc ino ma o f a ntrum

  • Ga stre c to my: 2 c m ma ss, mo de ra te ly

diffe re ntia te d a de no c a rc ino ma , o f a ntrum inva de s musc ula ris pro pria ; 2 ma lig na nt no dule s in pe rig a stric fa t; 0/ 16 lymph no de s with me ta sta sis

85

POP QUIZ

  • Wha t is the c o de fo r Summa ry Sta g e 2000?

a . 0 In situ b . 1 L

  • c a lize d o nly

c . 2 Re g io na l b y dire c t e xte nsio n o nly

  • d. 3 Re g io na l lymph no de (s) invo lve d o nly

e . 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

f.

5 Re g io na l NOS

g . 7 Dista nt

  • h. 9 Unkno wn

86

ST AGING & T RE AT ME NT PROCE DURE S

87

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SLIDE 30

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 30

E NDOSCOPY

  • Sta g ing -E

ndo sc o pic Ultra so und (E US)

  • De te rmine the de pth o f

tumo r inva sio n (T )

  • Me dia stina l a nd pe rig a stric

lymph no de s a re re a dily se e n a nd b io psie d b y E US (N)

  • Sig ns o f dista nt spre a d

ma y b e ide ntifie d (M)

http:/ / he a lth.usf.e d u/ me dic ine / inte rna l me dic ine / dig e stive / e us.htm

SURGE RY

  • E

ndo sc o pic Muc o sa l Re se c tio n

  • A sma ll c a p is fitte d o n the e nd o f the e ndo sc o pe

tha t ha s a sma ll wire lo o p.

  • F

luid is inje c te d unde r the no dule c re a ting a b liste r.

  • T

he no dule is suc tio ne d into the c a p a nd the wire lo o p is c lo se d while c a ute ry is a pplie d.

  • Co de a s 27
  • T

his ma y b e fo llo we d b y pho to dyna mic the ra py.

  • Co de 21

89

SURGE RY

  • E

so pha g e c to my

  • Re mo va l o f a se c tio n o f the e so pha g us.
  • E

so pha g us is re c o nstruc te d using a no the r o rg a n suc h a s the sto ma c h o r la rg e inte stine .

  • Co de 30
  • E

so pha g o g a stre c to my

  • Re mo va l o f a se c tio n o f the e so pha g us a nd the fundus o f the

sto ma c h.

  • Sto ma c h is surg ic a lly a tta c he d to the re ma ining e so pha g us.
  • Co de 53
  • E

n b lo c lymph no de disse c tio n

90

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SLIDE 31

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 31

T RE AT ME NT BY ST AGE

  • E

SOPHAG US

  • T

is-E MR o r Ab la tio n

  • T

1a

  • E

MR o r Ab la tio n

  • E

so pha g e c to my

  • T

1b N0-E so pha g e c to my

T RE AT ME NT BY ST AGE

  • E

SOPHAG US

  • T

2-T 4a a ny N

  • Pre o pe ra tive c he mo ra dia tio n
  • De finitive c he mo ra dia tio n
  • Pre fe rre d fo r c e rvic a l e so pha g us
  • Pre o pe ra tive c he mo the ra py
  • Only fo r a de no c a rc ino ma o f dista l

e so pha g us o r E GJ

  • E

so pha g e c to my

  • L
  • w risk le sio ns le ss tha n 2c m a nd we ll

diffe re ntia te d

  • T

4b -De finitive c he mo ra dia tio n

GAST RIC CANCE R SURGE RY

  • Re se c ta b le tumo rs
  • E

ndo sc o pic muc o sa l re se c tio n

  • Ga stre c to my (dista l, sub to ta l, o r to ta l) with re g io na l

lymph no de disse c tio n (15 o r mo re no de s)

  • Unre se c ta b le tumo rs
  • Ga stric b ypa ss with g a stro je juno sto my to pro xima l

sto ma c h

93

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E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 32

GAST RIC CANCE R SURGE RY

  • Co de 30 inc lude s:
  • Pa rtia l g a stre c to my, inc luding a sle e ve re se c tio n o f

the sto ma c h

  • Billro th I: a na sto mo sis to duo de num (duo de no sto my)
  • Billro th II

: a na sto mo sis to je junum (je juno sto my)

T RE AT ME NT BY ST AGE

  • ST

OMACH

  • T

is o r T 1a -E MR o r Surg e ry

  • T

1b N0-Surg e ry

  • T

2 o r hig he r a nd a ny N

  • Surg e ry o r
  • Pre o pe ra tive c he mo the ra py
  • Pre o pe ra tive c he mo ra dia tio n
  • M1-Pa llia tive the ra py

QUE ST IONS?

Quiz

96

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SLIDE 33

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 33

COMING UP…

  • Co lle c ting Ca nc e r Da ta : L

a rynx & T hyro id

  • 5/ 7/ 15
  • Co lle c ting Ca nc e r Da ta : Pa nc re a s
  • 6/ 4/ 15

97

AND T HE WINNE RS ARE … …

98

CE CE RT IF ICAT E QUIZ/ SURVE Y

  • Phra se

L initis Pla stic a

  • L

ink

  • http:/ / www.surve yg izmo .c o m/ s3/ 2073099/ Sto ma c h-a nd-

E so pha g us-2015

99