Implementing American Joint Committee on Cancer 8th edition for head-and-neck cancer in India: Context, feasibility, and practicality.

The American Joint Committee on Cancer (AJCC) 8th edition marks a paradigm shift in the staging of head-and-neck cancers. It introduces several novel considerations into the staging of head-and-neck cancer, with distinct therapeutic ramifications, to stage and prognosticate patients better. In oral cancer, it introduces the depth of invasion as a determinant of T-stage. The nodal staging recommendations have also upstaged extranodal extension, which has been shown to be a high-risk adverse feature associated with worse survival. In oropharyngeal cancer, human papillomavirus (HPV) expression of tumors has been used to reclassify tumors into two separate entities, with distinct staging systems. For HPV-positive tumors, nodal staging has been divided into clinical staging and pathological staging, for better prognostication of HPV-positive diseases treated with surgery. In carcinoma of unknown primaries with cervical nodal metastasis, immunohistochemical staining of nodal tissue for HPV and Epstein-Barr virus has been recommended in all cases. These recommendations are based on a high-quality evidence aimed at personalizing cancer therapy to optimize outcomes while minimizing morbidity. The new recommendations address many of the shortcomings of the previous editions. The practice of oncology in India, however, is markedly different from that in the Western world. Majority of these recommendations are universal; however, some are likely to have hurdles in implementation in India.