The fourth edition of the Manual for Staging of Cancer, prepared by the American Joint Committee on Cancer (AJCC), has just been published by J. B. Lippincott Company. The manual updates the TNM staging for malignant tumors at 50 anatomic sites. New sites added to the fourth edition include the small intestine and pleura. Refinements have also been made in the staging classification for many of the other sites. In addition, the defintions and rules for staging have been clarified, which should enable physicians and tumor registrars to categorize specific lesions more consistently. Also included are the new TNM staging classifications now recommended by the urologists and the gynecologists. Most importantly, all classifications and stage groupings listed in the manual are consistent with those published by the TNM Committee of the International Union Against Cancer (UICC).
Although the anatomic approach to cancer staging has probably reached an apogee, the AJCC continues to review selected sites, for example, pediatric tumors. In addition, the Committee is investigating other prognostic factors, such as ploidy, oncogene amplification, and suppressor gene loss, which may contribute to staging patients with cancer in the future. Combined with TNM, these other factors may improve the estimates of outcome and refine the evaluation of treatment.