%0 Journal Article
%T Major Changes in Head and Neck Staging for 2018
%A Brian O¡¯Sullivan
%A Snehal Patel
%A William Lydiatt
%J About the Ed Book | ASCO Educational Book
%D 2018
%R https://doi.org/10.1200/EDBK_199697
%X Staging cancers is an important tool for oncologists to define the natural history of disease, help to predict prognosis, support the surveillance community to facilitate cancer control at the registry level, and compare clinic trials across locales and is essential as a stratification factor for clinical and translational research. Periodic updates to staging systems are necessary to accurately reflect emerging data, differentiate novel diseases, and better capture the real-world experiences of clinicians and patients. The eighth edition of the AJCC Cancer Staging Manual (TNM classification from the American Joint Committee on Cancer [AJCC] and the Union for International Cancer Control [UICC]) reflects these principles.1-4 The AJCC head and neck task force, working with their partners in the UICC, sought to maintain harmony between the two dominant world systems for cancer staging as they introduced incremental staging changes, which took effect January 1, 2018. Three major changes to head and neck staging will be highlighted in this article, including adding depth of invasion to oral cavity cancer, introducing novel pathologic and clinical staging system for high-risk human papillomavirus¨Cpositive (HPV+)¨Cassociated oropharyngeal cancer (OPC), and the incorporation of extranodal extension (ENE) in nodal characterization in high-risk HPV¨Cnegative (HPV£¿) and non-nasopharyngeal carcinoma. This article and the accompanying oral presentation given at the 2018 ASCO Annual Meeting will highlight the AJCC/UICC staging changes, present the rationale for the changes, and provide preliminary data that have emerged. ANATOMY Section: ChooseTop of pageAbstractANATOMY <<DEPTH OF INVASIONTHE NEW TNM FOR HPV-POSIT...EXTRANODAL EXTENSION IN A...CONCLUSIONReferences A common misperception in the lay press is the conflation of the oropharynx with the oral cavity. Because each of the changes in staging discussed in this article are site dependent, a brief word on this distinction is important. Many press reports describe the high-risk HPV association with oral cancer. Although there are associations with HPV in the oral cavity, they are uncommon, and it is not apparent at this time what implication these have on the etiology or outcome of these cancers. What is clear is that HPV-related cancer of the oropharynx, determined by the surrogate immunohistochemical marker p16, is one of the most common cancers in the head and neck in the western world and is associated with a substantially better outcome for tumors in the OPC (specifically, cancers arising in the palatine and
%U http://ascopubs.org/doi/full/10.1200/EDBK_199697