The fourth edition of the TNM Classification was published in 1987,1 and a revision in 1992.2 It was the result of efforts by all national TNM Committees towards a worldwide uniform classification. The classifica tion criteria are identical with the fourth edition of the Manual for 3 Staging of Cancer of the American Joint Committee on Cancer (AJCC). Although the classification has found wide acceptance, some workers have pointed out that individual definitions and rules for staging are not sufficiently detailed. This can lead to inconsistent application of the clas sification. the antithesis of standardization. This source of differences in interpretation applies not only to the classification of individual organs but also to the general rules of the system, especially to the definitions of the requirements for the pathological classification (pT, pN). These are specified only for carcinoma of the breast; for other sites, reference must be made back to the general rules. which can lead to variable interpreta tions. The TNM Project Committee of the UICC has addressed this prob lem and collected and considered the criticisms and suggestions from the national TNM Committees as well as from cancer registries, oncolo gical associations and individual users. The result was the decision to complement the 4th edition of the TN M Classification 1.2. 3 with the publi cation of a TNM Supplement containing recommendations for the uni form use of TNM.

The TNM Supplement, 4th Edition, includes new, detailed definitions of anatomical sites, regional lymph nodes, and TNM categories. It answers questions that frequently arise during daily use of the TNM system. Importantly, the TNM Supplement expands on the minimum requirements for pathological classification of individal tumour sites and enumerates the recommended criteria for each. Published in association with the Union for International Cancer Control, it provides oncologists with complementary material related to TNM staging not covered in TNM Classification of Malignant Tumours, 7th Edition.

Metastases determine malignancy. The main attention so far has been focused upon organ metastases. The molecular mechanisms thereof, while far from being totally elucidated, are increasingly well understood. Modern diagnostic tools now enable detection and precise localization of small lesions. In contrast, our knowl edge and diagnostic capabilities regarding metastatic spread to the'lymphatic system are rather limited. However, there have re cently been a number of interesting advances. It is the aim of this volume to submit these developments to detailed analysis. The therapeutic relevance of enhanced sensitivity in detection of lymph node metastases has to be considered in the light of in creased morbidity versus eventual prognostic improvements by modification of therapy. An interesting concept which might im prove diagnostic accuracy while reducing operative morbidity is the "sentinel node" technique. Surgical standards are lacking, however, and many fundamental questions pertaining to precise lymphatic mapping remain unanswered. Whether the sentinel node concept is of general relevance or whether it is applicable in only a few organs remains to be determined. This book offers intensive discussion of the concept from methodological and tu mor biological viewpoints. World-renowned experts with long term involvement in related basic and clinical research provide the reader with a broad survey of actual knowledge together with a critical appraisal of recent and future developments. We sincerely hope this book succeeds in providing an outlook as a reference for all clinicians on future prospects and serving and researchers in this extremely important field.

The most comprehensive, multi-disciplinary text in the field, Cummings Otolaryngology: Head and Neck Surgery, 7th Edition, provides detailed, practical answers and easily accessible clinical content on the complex issues that arise for otolaryngologists at all levels, across all subspecialties. This award-winning text is a one-stop reference for all stages of your career—from residency and board certification through the challenges faced in daily clinical practice. Updated content, new otology editor Dr. Howard W. Francis, and new chapters and videos ensure that this 7th Edition remains the definitive reference in today's otolaryngology. - Brings you up to date with the latest minimally invasive procedures, recent changes in rhinology, and new techniques and technologies that are shaping patient outcomes. - Contains 12 new chapters, including Chronic Rhinosinusitis, Facial Pain, Geriatric Otology, Middle Ear Endoscopic Surgery, Pediatric Speech Disorders, Pediatric Cochlear Implantation, Tongue-Ties and Lip Ties, Laryngotracheal Clefts, and more. - Covers recent advances and new approaches such as the Draf III procedure for CRS affecting the frontal recess, endoscopic vidian and posterior nasal neurectomy for non-allergic rhinitis, and endoscopic approaches for sinonasal and orbital tumors, both extra- and intraconal. - Provides access to 70 key indicator (Accreditation Council for Graduate Medical Education Key Indicator Procedures), and surgical videos – an increase of 43% over the previous edition. - Offers outstanding visual support with 4,000 high-quality images and hundreds of quick-reference tables and boxes. - Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

This book will facilitate the understanding of cross-sectional anatomy details and assist radiation oncologists in the difficult task of a detailed delineation of lymph node targets in multiple anatomical locations.

M. K. Gospodarowicz, P. Hermanek, and D. E. Henson Attention to innovations in cancer treatment has tended to eclipse the importance of prognostic assessment. However, the recognition that prognostic factors often have a greater impact on outcome than available therapies and the proliferation of biochemical, molecular, and genetic markers have resulted in renewed interest in this field. The outcome in patients with cancer is determined by a combination of numerous factors. Presently, the most widely recognized are the extent of disease, histologic type of tumor, and treatment. It has been known for some time that additional factors also influence outcome. These include histologic grade, lymphatic or vascular invasion, mitotic index, performance status, symptoms, and most recently genetic and biochemical markers. It is the aim of this volume to compile those prognostic factors that have emerged as important determinants of outcome for tumors at various sites. This compilation represents the first phase of a more extensive process to integrate all prognostic factors in cancer to further enhance the prediction of outcome following treatment. Certain issues surround ing the assessment and reporting of prognostic factors are also considered. Importance of Prognostic Factors Prognostic factors in cancer often have an immense influence on outcome, while treatment often has a much weaker effect. For example, the influence of the presence of lymph node involvement on survival of patients with metastatic breast cancer is much greater than the effect of adjuvant treatment with tamoxifen in the same group of patients [5].

Rectal cancer is a major killer. Most of those dying after curative surgery suffer from recurrent disease in the pelvis. Local recurrence is also the only site of failure in up to 50% of patients. A disturbing fact is that the local recurrence rate shows considerably surgeon-related variances. There is now strong evidence that optimizing surgical technique by adopting the principle of total mesorectal excision (TME) will reduce local failure rate, increase the use of sphincter-saving operations, and improve functional results. Surgeons applying this surgical principle will consistently achieve similarly low recurrence rates.

Analytical Morphology is a new discipline dealing with the analysis of cell and tissue components using analytical maneuvers that go beyond those of conventional morphology and histopathology. It utilizes new advances in other disciplines, such as immunology, molecular biology, laser technology, microwave technology and computer science, to highlight cellular components such as peptides, proteins, or nucleotide sequences through chemical, physical, immunological, or molecular biological reactions. These methods include immunocytochemistry, in situ hybridization, in situ PCR, antigen retrieval, image analysis, and the like. The book is intended for morphological scientists, pathologists, advanced students, and technicians who are interested in keeping abreast of this rapidly emerging discipline.

This book is the 5th in an exceptional series which, in a most uncommon way, constitutes an original encyclopaedia of esophagology. It is devoted to a single subject: the esophagogastric junction. These few centimetres are dissected into 420 questions which call on all the disciplines involved by its physiology, its diverse diseases and their various treatments. 450 answers, provided by the most renowned experts, each one shedding light on one small, but essential, fragment of the subject. The book offers: A succesion of syntheses; A profusion of targeted bibliographical references; An access, now made easy, to highly elaborated knowledge; A precious volume for researchers, specialists, departments heads, general practitioners and students.

Conformal radiation therapy represents a new challenge. It offers the prospect of either increasing the radiation dose to target tissues while delivering a similar dose to organs at risk, or reducing the dose to organs at risk while maintaining the dose to target tissues. First, lymph node areas at risk are established using the available data from pathological examination. Then, based on a three-dimensional description of the anatomical regions, guidelines for the delineation of the clinical target volumes are proposed. The data presented should enable the reader to make appropriate decisions regarding the selection and delineation of the target volumes when confronted with the most frequent tumor types and sites.