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E so pha g us Sto ma c h 4/ 2/ 15 Collecting Cancer Data: Esophagus & Stomach 2014-2015 NAACCR We b ina r Se rie s April 2, 2015 Q&A Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r c o nte nt thro ug h the Q&A

  1. E so pha g us Sto ma c h 4/ 2/ 15 Collecting Cancer Data: Esophagus & Stomach 2014-2015 NAACCR We b ina r Se rie s April 2, 2015 Q&A • Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r c o nte nt thro ug h the Q&A pa ne l. Re minde r: • I f yo u ha ve pa rtic ipa nts wa tc hing this we b ina r a t yo ur site , ple a se c o lle c t the ir na me s a nd e ma ils. • We will b e distrib uting a Q&A do c ume nt in a b o ut o ne we e k. T his do c ume nt will fully a nswe r q ue stio ns a ske d during the we b ina r a nd will c o nta in a ny c o rre c tio ns tha t we ma y disc o ve r a fte r the we b ina r. 2 F ABUL OUS PRIZE S 3 NAACCR 2014-2015 We b ina r Se rie s 1

  2. E so pha g us Sto ma c h 4/ 2/ 15 KE Y ST AT IST ICS: E SOPHAGUS SURVIVAL E ST IMAT E D NE W CASE S AND DE AT HS • Ne w c a se s: 16,980 Sta g e 5- Ye a r Re la tive Surviva l Ra te • 13,570 in me n L o c a lize d 40% • 3,410 in wo me n Re g io na l 21% • De a ths: 15,590 Dista nt 4% • 12,600 in me n • 2,990 in wo me n Ame ric an Canc e r S o c ie ty Na tio na l Ca nc e r I nstitute ’ s Surve illa nc e , Canc e r F ac ts and F igure s 2015 E pide mio lo g y, a nd E nd Re sults (SE E R) KE Y ST AT IST ICS- ST OMACH E ST IMAT E D NE W CASE S SURVIVAL AND DE AT HS 5 ye a r Sta g e o b se rve d • Ne w c a se s: 24,590 surviva l • 15,540 in me n Sta g e IA 71% • 9,050 in wo me n Sta g e IB 57% • De a ths: 10,720 Sta g e I I A 46% • 6,500 in me n Sta g e I I B 33% • 4,220 in wo me n Sta g e I I I A 20% Sta g e I I I B 14% Ame ric an Canc e r S o c ie ty Sta g e I I I C 9% Canc e r F ac ts and F igure s 2015 Sta g e IV 4% Na tio na l Ca nc e r I nstitute ’ s SE E R da ta b a se HIST OL OGY • Sq ua mo us Ce ll Ca rc ino ma • T ypic a lly fo und in the uppe r two thirds o f the e so pha g us. • Ade no c a rc ino ma Z-L ine • Usua lly fo rms in the lo we r third o f the e so pha g us, ne a r the sto ma c h. NAACCR 2014-2015 We b ina r Se rie s 2

  3. E so pha g us Sto ma c h 4/ 2/ 15 BARRE T T ’S E SOPHAGUS • Re pe a te d e xpo sure to a c idic sto ma c h c o nte nts wa shing b a c k (re fluxing ) thro ug h the lo we r e so pha g e a l sphinc te r ma y c a use Z-L ine sq ua mo us c e lls to b e re pla c e d b y g la ndula r c e lls re se mb ling tho se c e lls in the sto ma c h. HIGH GRADE DYSPL ASIA/ CA IN SIT U PE R ST ANDARD SE T T E RS PE R AJCC MANUAL • Ple a se disc uss this issue with yo ur • Hig h g ra de dyspla sia c a nc e r c o mmitte e a nd/ o r inc lude s a ll no n inva sive pa tho lo g ists. ne o pla stic e pithe lia fo rma lly c a lle d c a rc ino ma in situ. • I f the y fe e l the se c a se s sho uld b e re po rte d a s c a rc ino ma in situ, ple a se • Ca rc ino ma in situ no lo ng e r do so . use d fo r c o lumna r muc o sa e a nywhe re in the dig e stive • I f the y do no t fe e l the se c a se s sho uld tra c t. b e pic ke d up a s c a rc ino ma in situ, do no t re po rt the m to SE E R, Co C, o r yo ur sta te re g istry . PROXIMAL VS. DIST AL Dista l • Pro xima l- T o wa rds the inc iso rs • Dista l-Awa y fro m the inc iso rs • T his is the sa me fo r the Pro xima l e ntire GI tra c t NAACCR 2014-2015 We b ina r Se rie s 3

  4. E so pha g us Sto ma c h 4/ 2/ 15 E SOPHAGUS OVE RVIE W • Ana to my 18 C15.0 C15.3 C15.1 C15.4 C15.1 C15.5 C15.2 (Ab do mina l e so pha g us) C16.0 C16.0 10 T OPOGRAPHY: ST OMACH • Ca rdia (C16.0) Cardia • F undus (C16.1) • Bo dy (C16.2) • Ga stric (Pylo ric ) Antrum (C16.3) • Pylo rus (C16.4) • L e sse r Curva ture (C16.5) • No t c la ssifia b le to C16.0 to C16.4 • Gre a te r Curva ture (C16.6) • No t c la ssifia b le to C16.0 to C16.4 • Sto ma c h NOS (C16.9) CS SCHE MA E SOPHAGUS • If the e pic e nte r o f tumo r is in the dista l e so pha g us a nd the c a rdia is invo lve d Ca rdia use the E so pha g us Sc he ma a nd the AJCC c ha pte r fo r E so pha g us NAACCR 2014-2015 We b ina r Se rie s 4

  5. E so pha g us Sto ma c h 4/ 2/ 15 CS SCHE MA E SOPHAGUSGE JUNCT ION • If the e pic e nte r o f a tumo r is in the E GJ o r in the pro xima l 5c m o f the Ca rdia sto ma c h a nd the c a rdia is invo lve d use the E so phagusGE J unc tio n Sc he ma a nd the AJCC c ha pte r fo r e so pha g us. POP QUIZ • T umo r is within 5c m o f the Ca rdia c a rdia a nd the c a rdia is invo lve d. • Wha t is the prima ry site ? • C16.2 Bo dy o f Sto ma c h • Wha t CS sc he ma wo uld b e use d to sta g e this c a se ? • E so pha g usGE Junc tio n POP QUIZ T umo r lo c a te d in the fundus o f the sto ma c h Ca rdia mo re tha n 5c m fro m the c a rdia . • Wha t is the prima ry site ? • C16.1 F undus o f Sto ma c h • Wha t CS sc he ma wo uld b e use d to sta g e this c a se ? • Sto ma c h NAACCR 2014-2015 We b ina r Se rie s 5

  6. E so pha g us Sto ma c h 4/ 2/ 15 L AYE RS OF T HE E SOPHAGE AL WAL L • Muc o sa • Surfa c e e pithe lium, la mina pro pria , a nd musc ula ris muc o sa • Sub muc o sa • Co nne c tive tissue , b lo o d ve sse ls, a nd g la nds • Musc ula ris (middle la ye r) • Stria te d a nd Smo o th musc le • Adve ntitia • Co nne c tive tissue tha t me rg e s with c o nne c tive tissue o f surro unding struc ture s • No S e ro sa 16 L AYE RS OF T HE ST OMACH WAL L Muc o sa l Sub muc o sa l Musc ula r Sub se ro sa l Se ro sa l I ma g e so urc e : SE E R T ra ining We b site 17 RUGAE • Rug a e a se rie s o f ridg e s pro duc e d b y fo lding o f the wa ll o f a n o rg a n. • Allo ws the sto ma c h e xpa nd whe n ne e de d. NAACCR 2014-2015 We b ina r Se rie s 6

  7. E so pha g us Sto ma c h 4/ 2/ 15 L INI T I S PL AST ICA • Spre a ds to the musc le s o f the sto ma c h wa ll a nd ma ke s it thic ke r a nd mo re rig id. L YMPHAT ICS OF T HE E SOPHAGUS • Dra ina g e is intra mura l a nd lo ng itudina l • Co nc e ntra tio n o f lympha tic c ha nne ls in the sub muc o sa a nd la mina pro pria • T he a na to mic site o f the c a nc e r a nd the no de s to whic h the site dra ins ma y no t b e the sa me . L YMPHAT ICS OF T HE ST OMACH • Gre a te r c urva ture • Gre a te r o me nta l • Pylo ric • Pa nc re a tic o duo de na l • Pa nc re a tic a nd Sple nic Are a • Pe ripa nc re a tic • Sple nic • L e sse r c urva ture • L e sse r o me nta l • L e ft g a stric • Ce lia c NAACCR 2014-2015 We b ina r Se rie s 7

  8. E so pha g us Sto ma c h 4/ 2/ 15 DIST ANT ME T AST ASIS: E SOPHAGUS • T he mo st c o mmo n site s a re : • L ive r • L ung s • Ple ura DIST ANT ME T AST ASIS: ST OMACH • T he mo st c o mmo n site s a re : • L ive r • Pe rito ne a l surfa c e • Dista nt lymph no de s GRADE • F o r E so pha g us a nd E GJ, g ra de is re q uire d to c a lc ula te AJCC sta g e s 0-I I A fo r b o th sq ua mo us c e ll c a rc ino ma a nd a de no c a rc ino ma • Gra de is no t re q uire d to de rive AJCC T NM sta g e fo r Sto ma c h • Sta nda rd fo ur g ra de g ra ding syste m • We ll diffe re ntia te d • Mo de ra te ly diffe re ntia te d • Po o rly diffe re ntia te d • Undiffe re ntia te d 23 GRADE • C T 1a N0 M0 G1 Sta g e I A • T re a tme nt o ptio ns inc lude • E so pha g e c to my • E ndo sc o pic muc o sa l re se c tio n • Othe r a b la tive te c hniq ue • C T 1a N0 M0 G2-3 Sta g e I B • E so pha g e c to my 24 NAACCR 2014-2015 We b ina r Se rie s 8

  9. E so pha g us Sto ma c h 4/ 2/ 15 ST AGING: E SOPHAGUS & ST OMACH 25 AJCC Ca nc e r Sta g e E SOPHAGUS & E SOPHAGOGAST RIC JUNCT ION (E GJ): CHAPT E R 10 26 AJCC CANCE R ST AGE : E SOPHAGUS & E GJ • I CD-O-3 T o po g ra phy Co de s • C15.0-C15.5, C15.8-C15.9 (e so pha g us) • C16.0 (E GJ) • C16.1 (fundus o f sto ma c h, pro xima l 5 c m o nly) • C16.2 (b o dy o f sto ma c h, pro xima l 5 c m o nly) • I CD-O-3 Histo lo g y Co de Ra ng e s • C15 o nly • 8000-8576, 8940-8950, 8980-8981 • C16 o nly • 8000-8152. 8154-8231, 8243-8245, 8247-8248, 8250-8576, 8940-8950, 8980-8981 27 NAACCR 2014-2015 We b ina r Se rie s 9

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