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Staging (Anus)
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Staging (Anus)
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Pathologic Staging (pTNM) AJCC 8th Edition CAP Approved Gastrointestinal • Appendix 4.0.0.0 AJCC 8th Edition
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
___ pTis: Carcinoma in situ (intramucosal carcinoma; invasion of the lamina propria or extension into but not through the muscularis mucosae)
___ pTis(LAMN): Low-grade appendiceal mucinous neoplasm confined by the muscularis propria. Acellular mucin or mucinous epithelium may invade into the muscularis propria. T1 and T2 are not applicable to LAMN. Acellular mucin or mucinous epithelium that extends into the subserosa or serosa should be classified as T3 or T4a, respectively.
___ pT1: Tumor invades the submucosa (through the muscularis mucosa but not into the muscularis propria)
___ pT2: Tumor invades the muscularis propria
___ pT3: Tumor invades through the muscularis propria into the subserosa or mesoappendix
___ pT4: Tumor invades the visceral peritoneum, including the acellular mucin or mucinous epithelium involving the serosa of the appendix or mesoappendix, and/or directly invades adjacent organs or structures
___ pT4a: Tumor invades through the visceral peritoneum, including the acellular mucin or mucinous epithelium involving the serosa of the appendix or serosa of the mesoappendix
___ pT4b: Tumor directly invades or adheres to adjacent organs or structures
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1: One to three regional lymph nodes are positive (tumor in lymph nodes measuring =0.2 mm), or any number of tumor deposits is present, and all identifiable lymph nodes are negative
___ pN1a: One regional lymph node is positive
___ pN1b: Two or three regional lymph nodes are positive
___ pN1c: No regional lymph nodes are positive, but there are tumor deposits in the subserosa or mesentery
___ pN2: Four or more regional lymph nodes are positive
Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Distant metastasis
___ pM1a: Intraperitoneal acellular mucin, without identifiable tumor cells in the disseminated peritoneal mucinous deposits#
___ pM1b: Intraperitoneal metastasis only, including peritoneal mucinous deposits containing tumor cells
___ pM1c: Metastasis to sites other than peritoneum
Specify site(s), if known: ______________________________ # Note: For specimens containing acellular mucin without identifiable tumor cells, efforts should be made to obtain additional tissue for thorough histologic examination to evaluate for cellularity.
Summary of changes AJCC 7th to 8th edition
- Tumor extension - acellular mucin now included
- Margins – acellular mucin now included
- N stage - based on number of involved lymph nodes
- M Stage – now includes acellular mucin, sub-divisions have changed