Radiation Oncology/Anal canal/Staging

Anal Cancer Staging

Current staging
AJCC 8th edition (2017)-

'NOTE:  All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition.  '

"In order to ensure that the cancer care community has the necessary infrastructure in place for documenting  8th Edition stage, the AJCC Executive Committee, in dialogue with the National Cancer Institute (NCI-SEER), Centers for Disease Control and Prevention (CDC), the College of American Pathologists (CAP), the National Comprehensive Cancer Network (NCCN, the National Cancer Data Base (NCDB), and the Commission on Cancer (CoC), made the decision to delay the implementation of the 8th Edition Cancer Staging System to January 1, 2018.

'''Clinicians will continue to use the latest information for patient care, including scientific content of the 8th Edition Manual. '' All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition.   The time extension will allow all partners to develop and update protocols and guidelines and for software vendors to develop, test, and deploy their products in time for the data collection and implementation of the 8th edition in 2018."'

(Source: https://cancerstaging.org/About/news/Pages/Implementation-of-AJCC-8th-Edition-Cancer-Staging-System.aspx)

Primary Tumor:
 * Tis - high-grade squamous intraepithelial lesion
 * T1 - 2 cm or less
 * T2 - >2 - 5 cm
 * T3 - >5 cm
 * T4 - invades adjacent organ, e.g. vagina, urethra, bladder. (invasion of the rectal wall, perirectal skin, subcutaneous tissue, or sphincter muscle is not included as T4.)

Regional Nodes:
 * Regional lymph nodes include: mesorectal, inguinal (superficial, deep), superior rectal (hemorrhoidal), external iliac, internal iliac (hypogastric)


 * N0 - no regional lymph node metastases
 * N1a - inguinal, mesorectal, or internal iliac lymph nodes
 * N1b - external iliac nodes
 * N1c - external iliac nodes + N1a

Distant Metastases:
 * M0 - no
 * M1 - yes

Stage grouping:
 * 0 - Tis
 * I - T1 N0
 * IIA - T2 N0
 * IIB - T3 N0
 * IIIA - T1-2 N1
 * IIIB - T4 N0
 * IIIC - T3-4 N1
 * IV - M1

Older staging systems
AJCC 7th edition (2009)

Primary Tumor:
 * Tis - carcinoma in situ
 * T1 - 2 cm or less
 * T2 - 2 - 5 cm
 * T3 - >5 cm
 * T4 - invades adjacent organ, e.g. vagina, urethra, bladder. (invasion of the rectal wall, perirectal skin, subcutaneous tissue, or sphincter muscle is not included as T4.)

Regional Nodes:
 * Regional lymph nodes include: perirectal, lateral sacral, internal iliac (hypogastric), inguinal


 * N0 - no lymph nodes
 * N1 - perirectal lymph nodes
 * N2 - unilateral internal iliac or (unilateral) inguinal lymph nodes or both
 * N3 - perirectal AND inguinal lymph nodes; and/or bilateral internal iliac; and/or (bilateral) inguinal lymph nodes

Distant Metastases:
 * M0 - no
 * M1 - yes

Stage grouping:
 * 0 - Tis
 * I - T1 N0
 * II - T2-3 N0
 * IIIA - T1-3 N1, T4 N0
 * IIIB - T4 N1, Any N2, Any N3
 * IV - M1

AJCC 6th Edition (2002) No changes compared to 7th edition