“Do you speak ocular tumor?” Dr. Finger asked this question in his thought-provoking editorial for the journal Ophthalmology nearly 20 years ago.1 Since then, there have been numerous advances in diagnostic and thera-peutic modalities for eye cancers. However, this question is just as relevant as it was 2 decades ago. The extent of tumor at presentation, defined by cancer staging, is an essential factor that determines disease prognosis, guides treatment planning, helps plan and evaluate clinical trials, and aids in the exchange and comparison of information across treatment centers.1,2 At a multicenter or global level, a uniform cancer classification is critical for clearly conveying clinical experience to others without ambiguity. A standardized cancer staging system enhances communication amongst specialists involved in tumor care: eye cancer specialists, pediatric oncologists, radiologists, radiation therapists, ophthalmic pathologists, geneticists, and researchers. With this in mind, Dr. Finger led the pursuit to develop the most scientifically sound language to address eye cancers: the AJCC eye cancer staging system (Mind map 8-1).
The AJCC, in conjunction with its international counterpart, the Union for International Cancer Control (UICC), joined forces to develop a consensus staging system for cancers of the eye, lids, and orbit. Dr. Finger was selected to chair the 7th edition AJCC effort for ophthalmic oncology in 2003. His philosophy to approach this task was “what is made by the community will be used by the community” (see Chapter 1). Upon review of their research and clinical reputation, Dr. Finger rallied to bring the leading specialists in each tumor type to the discussion table and laid the foundations of the AJCC-OOTF.
The process involved the formation of expert clinical and pathology peer review. An initial group re-examined the literature for each type of eye cancer and synthesized an evidence-based medical consensus on paper. Another group of similar experts critically reviewed the staging proposal. Both teams reviewed the final draft. This process was conducted through monthly phone meetings and periodic in-person discussions over 4 years. The community’s efforts resulted in the 7th edition AJCC eye cancer staging system in 2009.3 As the AJCC staging system is periodically updated with newly available medical evidence, the 8th edition of AJCC staging was drafted with the participation of 58 specialists from 13 countries.4
Since its publication, this staging system has become universally accepted by tumor registries worldwide, prominent ophthalmology journals, and their associated societies. The widespread utilization of ophthalmic AJCC staging can be revealed by searching PubMed for the terms “AJCC” and “eye”. One of the major advantages of the AJCC TNM staging system is that it can be modified in response to newly acquired clinical and pathologic data, improved understanding of cancer biology, and other factors affecting prognosis. The evidence-based modifications are made meticulously, and the revision cycle usually spans 5–7 years. The intent is to provide ample time for implementing changes in clinical management and cancer registry operations.
Herein, we discuss the impact of AJCC staging by outlining how it has improved the abilities of eye cancer specialists and thus saved the lives of patients.