Uterine Cervix - Hysterectomy (SUTCH)

- For hysterectomy, trachelectomy, or pelvic exenteration with invasive carcinoma of the cervix

Specimen and Surgical Procedure

Specimen, procedure...................................................................

Lymph nodes submitted and/or identified in the specimen................ yes/no

Tumor

Tumor site..................................................................................

       Classify as

       - Left superior quadrant (12 to 3 o’clock)

- Left inferior quadrant (3 to 6 o’clock)

- Right inferior quadrant (6 to 9 o’clock)

- Right superior quadrant (9 to 12 o’clock)

- Indeterminate

Is tumor grossly visible?............................................................... yes/no

Tumor size.................................................................................. __ cm

Histologic type............................................................................

Histologic grade..........................................................................

Stromal invasion

       Depth (in mm; from epithelial-stromal junction).....................

       Thickness of cervical wall (in mm)........................................

       % invasion of wall..............................................................

       Horizontal extent (in mm)...................................................

Lymph-vascular invasion.............................................................. present/absent        

Final Margins

Nearest margin............................................................................

Distance from specified margin to tumor.........................................

Vaginal margin......................................................................... positive/negative

       HSIL at margin............................................................ present/absent

Right parametrial margin........................................................... positive/negative

Left parametrial margin............................................................. positive/negative

Lymph Nodes

Pelvic lymph nodes (involved/examined).............................................. __/__

Para-aortic lymph nodes (involved/examined)...................................... __/__

Other lymph nodes (involved/examined).............................................. __/__

Pathologic stage........................................................................ pT__N__M__

Gynecologic

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