Pathologic Staging (pTNM, AJCC 8th Edition)

CAP Approved Gynecologic • Ovary, Fallopian Tube 1.0.0.0

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor limited to ovaries (one or both) or fallopian tube(s)

___ pT1a: Tumor limited to one ovary (capsule intact) or fallopian tube, no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings #

___ pT1b: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings

___ pT1c: Tumor limited to one or both ovaries or fallopian tubes with any of the following:

___ pT1c1: Surgical spill

___ pT1c2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface

___ pT1c3: Malignant cells in ascites or peritoneal washings

___ pT2: Tumor involves one or both ovaries or fallopian tubes with pelvic extension below pelvic brim or primary peritoneal cancer

___ pT2a: Extension and/or implants on uterus and/or fallopian tube(s) and/or ovaries.

___ pT2b: Extension to and/or implants on other pelvic tissues.

___ pT3: Tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer with microscopically confirmed peritoneal metastasis outside the pelvis and/or metastasis to retroperitoneal (pelvic and/or para-aortic) lymph nodes

___ pT3a: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes

___ pT3b: Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension with or without metastasis to retroperitoneal lymph nodes

___ pT3c: Macroscopic peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension with or without metastasis to the retroperitoneal lymph nodes (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ)

# Note: Serous tubal intraepithelial carcinoma (STIC) should be staged as pT1a if it involves one tube only, as pT1b if it involves both tubes, and as pT1c3 if it is accompanied by positive peritoneal washing washings or ascites. Nonmalignant ascites is not classified. The presence of ascites does not affect staging unless malignant cells are present.

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastasis

___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm

___ pN1: Positive retroperitoneal lymph nodes only (histologically confirmed)

___ pN1a: Metastasis up to and including 10 mm in greatest dimension

___ pN1b: Metastasis more than 10 mm in greatest dimension

Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ pM1: Distant metastasis, including pleural effusion with positive cytology; liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); and transmural involvement of intestine

___ pM1a: Pleural effusion with positive cytology

___ pM1b: Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine

Specify site(s), if known: ____________________________

Note: Parenchymal liver or splenic metastasis is classified as stage IV disease, whereas liver or splenic capsule metastasis is classified as stage III disease. Non-regional lymph node metastases (such as inguinal, supraclavicular, and axillary nodes) are considered M1. Involvement of surface of diaphragm is considered pT3; however, involvement of skeletal muscle of diaphragm or abdominal wall tissue beyond the peritoneum is considered distant metastasis (M1).

Ovary, Fallopian Tube CAP 1.0.0.0 summary of pTNM changes AJCC 7th to 8th edition

1. Ovary, fallopian tube and primary peritoneal tumors now combined into one staging system
2. Serous tubal intraepithelial carcinoma is now pT1 (a,b,or c), not pTis
3. Tubal carcinoma now required to be divided into pT1a/b/c, not just recommended
4. pT1c now subdivided into c1/c2/c3 based on surgical spill/capsule ruptured before surgery or tumor on ovary or tube surface/positive ascites or peritoneal washings
5. Positive ascites or peritoneal washings no longer impacts pT2c category, i.e. pT2c no longer exists
6. Retroperitoneal lymph node metastasis can now be either pT3b or pT3c, not just pT3c
7. New pN0(i+) category for isolated tumor cells
8. pN1 subdivided into N1a and N1b based on metastasis ≤10 mm and >10mm
9. Transmural involvement of intestine is now considered pM1
10. pM1 subdivided into M1a (positive pleural effusion) and M1b (other metastases)
11. Grossing changes: if omentum grossly negative, submit 5 blocks with 2 sections in each block.

Gynecologic

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