Introduction of 7th AJCC TNM Staging for Liver and Intrahepatic Bile Duct Malignancies

PURPOSE: Cancer staging is essential in clinical cancer practice in medical and surgical oncology. Staging based on the guidelines of the American Joint Committee on Cancer (AJCC) is the most popular and is widely used in clinical fields. Early this year, the 7th edition of the AJCC cancer staging manual was published. I have compared and described the changes in the new edition from the older version to facilitate staging in clinical settings, especially for liver and intrahepatic bile duct malignancies. METHODS: On the basis of the new 2010 edition of the 7th AJCC TNM cancer staging manual, I have compared hepatobiliary malignancy in Chapter 18, liver malignancy and intrahepatic bile duct malignancy in Chapter 19. RESULTS: One of the major changes in the 7th AJCC manual compared to the 6th AJCC staging manual published in 2002 is separation of the Liver and Intrahepatic bile duct cancer chapters. In the previous edition, intrahepatic bile duct cancer was included in the liver malignancy chapter. CONCLUSION: There are no universal and permanent staging systems for cancer. The staging systems are ever changing to adjust for changes in treatment and prognosis of malignancies. We need to collect data in order to modify the staging correctly in collaboration with multi-institutional efforts to reduce biases in staging liver and intrahepatic bile duct cancers.

A Clinical Study of Gallbladder Polyps

PURPOSE: Gallbladder cancer had poor prognosis because it is usually detected at a late stage. Some GB polyps are diagnosed as cancerous on the postoperative pathology. Because of the significance of the early detection of the cancer, the relationship between GB polyp and cancer is important. METHODS: From January 1994 to May, 2004, 94 cases of GB polypoid lesions were identified and diagnosed after cholecystectomy was performed at the Korea University Medical Center Anam hospital. The pateints' age, gender, the symptoms and signs, the diagnostic tools, the operative methods and the histopathologic findings were investigated. RESULTS: For the 94 patients, the mean age was 50.3+/-13.1 years and there were 42 males (44.7%). 92 patients were evaluated by abdominal ultrasonography, and it had a sensitivity of 72.8%. On the histopathologic results, there were 76 cases of benign polyps and 18 cases of malignant polyps. The diameter of the malignant polyps was 17.3+/-8.5 mm and the diameter of the benign polyps was 6.4+/-3.0 mm, so the malignant polyps were larger than the benign polyps. The mean age of the malignant polyp group was 62.6+/-14.2 years and the mean age of the benign polyp group was 47.1+/-11.1. The patients of the malignant polyp group were older than the patients of the benign polyp group. 19 GB polyps were greater than 10 mm in diameter and among them, there were 15 cases of malignant polyps (78.94%). CONCLUSION: The size of the polyps and the patient's age could be risk factors for malignant polyps, and the malignant potential was high for the polyps that exceeded 10 mm and for a patient age that exceeded 60 years. Surgical treatment is recommended for these patients.