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Free Content Overcoming “Stage” Fright: American Joint Committee on Cancer 8th Edition Pharyngeal Cancer Update

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Significant changes to the staging system for pharyngeal cancers are contained within the recently implemented American Joint Committee on Cancer 8th Edition Cancer Staging Manual and reflect current prognoses and treatment options. This article reviews changes particularly relevant to radiologists and highlights the critical role that radiologists play in the diagnosis and staging of head and neck cancer. By using multimodality case examples, nasopharyngeal, oropharyngeal, and hypopharyngeal carcinomas are emphasized as well as the newly described entity of radiologically overt extranodal extension.

Learning Objectives: 1) Compare the American Joint Committee on Cancer 7th Edition description of T4 disease versus the 8th edition description of T2 disease for nasopharyngeal carcinoma, 2) explain the relationship between the Epstein-Barr virus and nasopharyngeal carcinoma as well as the human papillomavirus and p16+ oropharyngeal cancer, and 3) describe the impact of extranodal extension on clinical staging for cervical nodal metastasis in the setting of an unknown primary tumor, as well as for p16− oropharyngeal and hypopharyngeal cancers.
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Keywords: 7th Edition = American Joint Committee on Cancer 7th Edition Cancer Staging Manual; 8th Edition = American Joint Committee on Cancer 8th Edition Cancer Staging Manual; AJCC = American Joint Committee on Cancer; EBV = Epstein-Barr virus; EBV+ = tests positive for EBV; EBV− = tests negative for EBV; ENE = extranodal extension; ENE(+) = positive for ENE; ENE(−) = negative for ENE; HPC = hypopharyngeal cancer; HPV = human papillomavirus; NPC = nasopharyngeal carcinoma; OPC = oropharyngeal squamous cell cancer; TNM = tumor, node, metastasis; cENE = clinically overt extranodal extension; p16+ = p16 overexpression; p16− = p16 underexpression or no expression; pENE = pathologically proven extranodal extension; rENE = radiologically overt extranodal extension

Document Type: Research Article

Publication date: April 1, 2019

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  • Neurographics is the peer-reviewed, bimonthly educational journal of the American Society of Neuroradiology. The journal comprises articles selected from material presented at the ASNR Annual Meeting. Neurographics also publishes other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Neurographics offers CME credit for reading review articles and completing quiz-based self-assessment activities. CME credit for review articles may be claimed up to 3 years after an article's publication date. Visit to view all available CME courses.
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