AMERICAN JOINT COMMITTEE ON CANCER
AJCC
CANCER STAGING
ATLAS
EDITORS
FREDERICK L. GREENE, m.d.
Chair, Department of General Surgery Carolinas Medical Center Charlotte, North Carolina CAROLYN C. COMPTON, m.d., ph.d Director of Biorepositories and Biospeciment Research
National Cancer Institute Bethesda, Maryland APRIL G. FRITZ, c.t.r., r.h.i.t.
Division of Cancer Control and Population Sciences National Cancer Institute
Bethesda, Maryland JATIN P. SHAH, m.d.
Chief, Head and Neck Service Memorial Sloan-Kettering Cancer Center
New York, New York DAVID P. WINCHESTER, m.d.
Professor and Chair, Department of Surgery Evanston Northwestern Healthcare
Evanston, Illinois
AJCC
CANCER STAGING ATLAS
AMERICAN JOINT COMMITTEE ON CANCER Executive Office
633 North Saint Clair Street Chicago, Illinois 60611 FOUNDING ORGANIZATIONS
American Cancer Society American College of Physicians American College of Radiology American College of Surgeons College of American Pathologists
National Cancer Institute SPONSORING ORGANIZATIONS
American Cancer Society American College of Surgeons American Society of Clinical Oncology Centers for Disease Control and Prevention
LIAISON ORGANIZATIONS American Urological Association Association of American Cancer Institutes
National Cancer Registrars Association North American Association of Central Cancer Registries
American Society of Colon and Rectal Surgeons Society of Gynecologic Oncologists
Society of Urologic Oncology
American Joint Committee on Cancer Executive Office
633 North Saint Clair Street Chicago, IL 60611, USA Editors:
Frederick L. Greene, M.D. Carolyn C. Compton, M.D., PH.D.
April G. Fritz, C.T.R., R.H.I.T. Jatin P. Shan, M.D.
David P. Winchester, M.D.
Illustrator: Alice Y. Chen
This atlas was prepared and published through the support of the American Cancer Society, the Amer- ican College of Surgeons, the American Society of Clinical Oncology, the Centers for Disease Control and Prevention, and the International Union Against Cancer.
Library of Congress Control Number: 2005932559 ISBN-10: 0-387-29014-1
ISBN-13: 978-0387-29014-0 Printed on acid-free paper.
© 2006 Springer Science+Business Media, Inc.
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.
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While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal respon- sibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
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American Joint Committee on Cancer • 2006 v Preface
This first edition of the AJCC Cancer Staging Atlas has been created as a com- pendium to the AJCC Cancer Staging Manual and Handbook which have now been developed through six editions and which continue to promulgate the importance of anatomical and pathological staging in the management of cancer. This Atlas has been viewed as a companion to illustrate the TNM clas- sifications of all the regions included under the head and neck, digestive, tho- racic, musculoskeletal, soft tissue, breast, genital, urinary and gynecologic sites.
This monograph has been fully illustrated to give meaningful visualization to the TNM classifications and stage groupings and will serve as a useful reference for the clinician and patient alike.
Since there have been changes in staging strategies in the 6th Edition of the AJCC Cancer Staging Manual, the differences between the 5th edition and 6th edition have been included throughout the Atlas. This will provide a meaning- ful comparison for the experienced clinician as well as serve as a teaching refer- ence for the student and trainee.
The 432 outstanding illustrations have been developed exclusively for the AJCC Cancer Staging Atlas by Alice Y. Chen, our exceptional medical illustrator.
Every illustration provides detailed and thorough anatomic depictions to clarify critical structures and to allow the reader to instantly visualize the progressive extent of malignant disease. Appropriate labeling has been incorporated to iden- tify significant anatomic structures. A significant number (28%) of the illustra- tions are devoted solely to the representation of the TNM changes which are new in the AJCC Cancer Staging Manual, 6th Edition. Throughout all anatomic sites, the newly developed illustrations reflect concepts that are more completely discussed in the AJCC Cancer Staging Manual and Handbook.
The AJCC Cancer Staging Atlas is an official publication of the American Joint Committee on Cancer and reinforces the AJCC’s position as the leader in disseminating state of the art information on TNM staging. The AJCC contin- ues to have as its mission the education of physicians, registrars and patients.
The Atlas, a portable and easily referenced representation of the AJCC mono- graphs, continues to enhance this mission. This project has been fully supported by our publishing colleagues at Springer and especially Laura diZerega and Bill Curtis, our longtime friends and AJCC supporters.
The editors of this most recent AJCC project wish to reinforce the concept that TNM is a universal “language” which must be applied by all clinicians caring for the cancer patients. In order to make this language come alive, a pictorial representation of clinical and pathological staging is necessary. We dedicate this work to all of our patients and colleagues and hope that they too will benefit from this illustrated resource.
Frederick L. Greene, m.d.
Carolyn C. Compton, m.d., ph.d.
April G. Fritz, c.t.r., r.h.i.t.
Jatin P. Shah, m.d.
David P. Winchester, m.d.
American Joint Committee on Cancer • 2006 vii Contents
Preface . . . . v
1. Purposes and Principles of Staging . . . . 1
Part I . . . . 11
Head and Neck Sites 2. Introduction to Head and Neck Sites . . . . 13
3. Lip and Oral Cavity . . . . 19
4. Pharynx (Including Base of Tongue, Soft Palate, and Uvula) . . . . 27
5. Larynx . . . . 41
6. Nasal Cavity and Paranasal Sinuses . . . . 53
7. Major Salivary Glands (Parotid, Submandibular, and Sublingual) . . . . 61
8. Thyroid . . . . 67
Part II . . . . 75
Digestive System 9. Esophagus . . . . 77
10. Stomach . . . . 89
11. Small Intestine . . . . 101
12. Colon and Rectum . . . . 107
13. Anal Canal . . . . 119
14. Liver (Including Intrahepatic Bile Ducts) . . . . 127
15. Gallbladder . . . . 133
16. Extrahepatic Bile Ducts . . . . 139
17. Ampulla of Vater . . . . 147
18. Exocrine Pancreas . . . . 155
viii American Joint Committee on Cancer • 2006
Part III . . . . 165
Thorax 19. Lung . . . . 167
20. Pleural Mesothelioma . . . . 177
Part IV . . . . 183
Musculoskeletal Sites 21. Bone . . . . 185
22. Soft Tissue Sarcoma . . . . 191
Part V . . . . 195
Skin 23. Carcinoma of the Skin (Excluding Eyelid, Vulva, and Penis) . . . . 197
24. Melanoma of the Skin . . . . 207
Part VI . . . . 217
Breast 25. Breast . . . . 219
Part VII . . . . 235
Gynecologic Sites 26. Vulva . . . . 237
27. Vagina . . . . 243
28. Cervix Uteri . . . . 249
29. Corpus Uteri . . . . 259
30. Ovary . . . . 265
31. Fallopian Tube . . . . 273
32. Gestational Trophoblastic Tumors . . . . 279
Part VIII . . . . 285
Genitourinary Sites 33. Penis . . . . 287
34. Prostate . . . . 293
American Joint Committee on Cancer • 2006 ix
35. Testis . . . . 303
36. Kidney . . . . 315
37. Renal Pelvis and Ureter . . . . 323
38. Urinary Bladder . . . . 329
39. Urethra . . . . 337
Index . . . . 347
