The College of American Pathologists (CAP) has released updated cancer reporting protocols, including several changes to how head and neck cancers are classified and reported in pathology laboratories.
CAP Cancer Protocols are widely used to ensure that pathology reports include all key information needed for diagnosis, staging, and treatment planning. They are based on established standards, including the World Health Organization (WHO) tumor classifications and the American Joint Committee on Cancer (AJCC) staging system, and support consistent, structured reporting across institutions.
“The updated Head and Neck sections of the CAP Cancer Protocols reflect CAP’s continued commitment toward precise, clinically actionable reporting and alignment with major guidelines and staging principles,” says M. E. de Baca, Chair of the CAP’s Council on Informatics and Pathology Innovation. “In addition to content updates and harmonization, the revisions now set standards for the incorporation of multidisciplinary stakeholder input into the protocols. They also lay out an approach to splitting and ‘retiring’ protocols, largely as an adaptation to the asynchronous release of AJCC staging systems.”
“Importantly, these updates rest on the standardized data backbone of the electronic protocols, which ensures high-fidelity transmission of patient information across systems, supporting consistency, interoperability, and downstream use,” adds de Baca.
A key change in this update is a restructuring of head and neck protocols. Older, broader protocols – such as those for the pharynx and major salivary glands – have been retired and replaced with more specific, site-based protocols. These include separate protocols for HPV-associated oropharyngeal cancer, HPV-independent disease, nasopharyngeal tumors, salivary gland tumors, and mucosal melanoma.
This shift reflects a growing understanding that different tumor types, particularly those linked to human papillomavirus (HPV), behave differently and require distinct approaches to diagnosis and staging.
The update also introduces AJCC Version 9 staging for several head and neck cancers, incorporating newer criteria into routine reporting.
Changes to reporting elements are another key feature. A new section on tumor bed margin status has been added, and lymph node reporting has been expanded. Some data points that were previously optional are now required, emphasizing their importance for clinical decision-making.
Biomarker reporting has also been revised. Updates include clearer criteria for HER2 scoring, removal of some earlier interpretation questions, and the addition of new antibodies. Terminology has been refined in areas such as SWI/SNF complex–deficient sinonasal carcinoma to improve clarity and consistency.
Additional updates aim to standardize how tumors are described, including refinements to tumor site definitions, histologic classification, and lymph node terminology. These changes are intended to improve consistency across reports and support accurate coding and data sharing.
Overall, the updates reflect ongoing changes in how head and neck cancers are understood and classified, particularly as molecular and biomarker information becomes more integrated into diagnosis and treatment planning.
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