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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
7. About the MANUAL – not about stage
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
2010 – 7th Edition
2016 – 8th 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
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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T H E B O O K L O O K
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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
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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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
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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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
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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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
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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T H E B O O K L O O K
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CHAPTER FORMAT
• Anatomy
• Rules for Classification
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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T H E B O O K L O O K
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T H E B O O K L O O K
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CHAPTER FORMAT
• Prognostic Factors
• Risk Assessment Models
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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T H E B O O K L O O K
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CHAPTER FORMAT• Definitions for AJCC TNM
• AJCC Prognostic Stage Groups
• Registry Data Collection Variable
• Histologic Grade
• Histological Type
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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T H E B O O K L O O K
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T H E B O O K L O O K
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CHAPTER FORMAT
• Survival Data (sometimes)
• Illustrations (sometimes)
• Bibliography
Source: AJCC cancer Staging Manual, 8th Edition
T H E B O O K L O O K
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T H E B O O K L O O K
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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
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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• 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
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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• 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
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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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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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 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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