Scenario:
- Patient presented with Rectal Primary cT2 cN2a cM0 Stage 3B Grade 3 Adenocarcinoma
- Treatment Plan: Total neo-adjuvant therapy followed by consolidative proctocolectomy with perhaps formation of a permanent colostomy pending response to treatment
- Patient treated with Neoadjuvant Chemo/XRT
- After neoadjuvant therapy complete Flexible Sigmoidoscopy shows no visible cancer, biopsies negative. Scans show no evidence of viable disease, no adenopathy, no mets
- Hem Onc-Because of the findings on flexible sigmoidoscopy and the biopsy results that provides patient with 2 options. Option 1 is surveillance. This would mean performing a flexible sigmoidoscopy every 3 months with biopsy. Option 2 involves surgical resection. After careful consideration, the patient has elected to undergo serial examinations.
Question: Is this patient eligible for yc Posttherapy Stage?
- Yes
- No
Answer: Yes- assign yc Posttherapy Stage After planned neoadjuvant therapy and surgery was not done because patient responded so well to neoadjuvant treatment-surgery not needed.
Fields to consider.
| AJCC Clin Stage | yc2 cN2a cM0 Stage 3B
|
|
| AJCC Path Stage | Blank
|
Not eligible for Path Stage-patient treated with neoadjuvant therapy |
| AJCC Post therapy (yc) Stage | ycT0 ycN0 cM0 Stage 99
|
ycT0 (no evidence of rectal tumor on sigmoidoscopy or scans after neoadjvuant rx)
ycN0 cM0 (no evidence of lymph node or metastatic disease on scans after neoadjvuant therapy) |
| AJCC Post therapy (yp) Stage | BLANK | Not eligible for yp Stage-surgery not done |
| Grade Clinical | 3 | |
| Grade Pathological | 9 | Grade Path cannot be blank |
| Grade Post therapy Clin yc | 9 | Grade Manual Note 4: Code 9 (unknown) Grade Post Therapy Clin *(yc) when
x Microscopic exam is done after neoadjuvant therapy and there is no residual cancer |
| Grade Posttherapy Path yp | BLANK | Grade Manual Note 1: Leave Grade Post Therapy Path (yp) blank when
x Neoadjuvant therapy completed; surgical resection not done |
Discussion:
We are seeing a trend when AJCC yc Stage Clinical Stage is not being assigned, as well as yc Grade when it’s applicable. Be sure to review the presentation linked below, there are several other situations where AJCC yc stage will be assigned when surgery is not done after neoadjuvant therapy, be sure to review the AJCC yc Stage Classification-When and How to Use it