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

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.