Intestine with tumor: Difference between revisions

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+System
Line 34: Line 34:
*Depth of tumor invasion and/or infiltration
*Depth of tumor invasion and/or infiltration
{{Reporting}}
{{Reporting}}
==Microscopic evaluation==
Determine tumor type and differentiation.
In case of cancer, stage by the AJCC or TNM system:
===Overall AJCC stage===
{| class=wikitable
|-
! [[AJCC staging system|AJCC stage]]<ref name=CancerStagingManual>{{cite web|url=https://www.cancer.net/cancer-types/colorectal-cancer/stages|title=Colorectal Cancer: Stages|website=Cancer.net (American Society of Clinical Oncology)|accessdate=2019-09-26}} Approved by the Cancer.Net Editorial Board, 11/2018. In turn citing:<br>{{cite journal|last1=Amin|first1=Mahul B.|last2=Greene|first2=Frederick L.|last3=Edge|first3=Stephen B.|last4=Compton|first4=Carolyn C.|last5=Gershenwald|first5=Jeffrey E.|last6=Brookland|first6=Robert K.|last7=Meyer|first7=Laura|last8=Gress|first8=Donna M.|last9=Byrd|first9=David R.|last10=Winchester|first10=David P.|title=The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging|journal=CA: A Cancer Journal for Clinicians|volume=67|issue=2|year=2017|pages=93–99|issn=00079235|doi=10.3322/caac.21388}}</ref>
! [[TNM staging system|TNM stage]]<ref name=CancerStagingManual/>
! TNM stage criteria<ref name=CancerStagingManual/>
|-
|Stage 0
|Tis N0 M0
|Tis: Tumor confined to [[mucosa]]; cancer-''in''-''situ''
|-
|rowspan=2| Stage I
|T1 N0 M0
|T1: Tumor invades [[submucosa]]
|-
|T2 N0 M0
|T2: Tumor invades [[muscularis propria]]
|-
|Stage II-A
|T3 N0 M0
|T3: Tumor invades subserosa or beyond (without other organs involved)
|-
|Stage II-B
|T4a N0 M0
|T4a: Tumor perforates the visceral [[peritoneum]]
|-
|Stage II-C
|T4b N0 M0
|T4b: Tumor invades adjacent organs
|-
|Stage III-A
|
*T1-2 N1 M0 or
*T1, N2a, M0
|
*N1: Tumor cells in 1 to 3 regional [[lymph node]]s. T1 or T2.
*N2a: Tumor cells in 4 to 6 regional lymph nodes. T1
|-
|Stage III-B
|
*T3-4a, N1 M0 or
*T2-3, N2a, M0 or
*T1-2 N2b M0
|
*N1: Tumor cells in 1 to 3 regional lymph nodes. T3 or T4
*N2a: Tumor cells in 4 to 6 regional lymph nodes. T2 or T3
*N2b: Tumor cells in 7 or more regional lymph nodes. T1 or 2
|-
|Stage III-C
|
*T4a N2a M0 or
*T3-4a N2b M0 or
*T4b N1-2, M0
|
*N2a: Tumor cells in 4 to 6 regional lymph nodes. T4a
*N2b: Tumor cells in 7 or more regional lymph nodes. T3-4a
*N1-2: Tumor cells in at least one regional lymph node. T4b
|-
|Stage IVa
| any T, any N, M1a
| M1a: Metastasis to 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N.
|-
|Stage IVb
| any T, any N, M1b
| M1b: Metastasis to more than 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N.
|-
|Stage IVc
| any T, any N, M1c
| M1c: Metastasis to the peritoneal surface. Any T, any N.
|}


==Microscopy report==
==Microscopy report==
Line 45: Line 120:
:*Number of them with metastases
:*Number of them with metastases
:*Number of them with periglandular growth
:*Number of them with periglandular growth
{{Reporting}}
{{Bottom}}
{{Bottom}}

Revision as of 10:40, 26 September 2019

Author: Mikael Häggström [note 1]

Gross examination

  • Determine the proximal (oral) and distal (aboral) parts of the specimen if possible.[1]
  • Measure the length and diameter of the entire specimen.[1]
  • Surfaces that appear to overlie a tumor can be inkedTemplate:Ink note.
  • Initial cutting can be:
  • A longitudinal cut opposite to the tumor if it is relatively demarcated (by sight and/or palpation).
  • Transverse (cross-sectional) slicing, until reacing the tumor, particularly for circumferential tumors.
  • Measure the distance proximal and distal to the tumor.[1]
  • Note any accompanying "polyps".[1]
  • Describe the serosa, and whether there are any suspected tumor breakthroughs hereof.[1]
  • Evaluate the following either before or after slicing it up:[1]
  • Tumor size
  • The proportion of the circumference involved
  • Slice the tumor, either by transverse or longitudinal slicing.[1]
  • Review each slice and note the depth (in terms of anatomic layer, possibly with rough percentage thereof) and distance to the serosa or transverse resection margin for any tumor invasion and/or infiltration.[1]

Tissue selection

Should include:[1]

  • The tumor slices that show the deepest penetration. The slices should include tumor relation to the serosa or resection margin, as well as adjacent normal mucosa.
  • Proximal and distal resection margin, respectively. Take transverse slices except if the tumor is critically close to the margin, in which case it is advisable to take slices perpendicular to that margin, including both the tumor border and the resection margin.
  • Take slices of any other suspicious findings
  • Take a slice of the normal intestinal wall
  • Take slices from any adherent structures and/or organ parts
  • Carefully go through included mesentery for lymph nodes, and cut each in two parts.

Gross report

Should include:[1]

  • Dimensions of entire sample, as well as for the tumor
  • Distance to proximal and distal resection margins
  • Depth of tumor invasion and/or infiltration

  See also: General notes on reporting


Microscopic evaluation

Determine tumor type and differentiation.

In case of cancer, stage by the AJCC or TNM system:

Overall AJCC stage

AJCC stage[2] TNM stage[2] TNM stage criteria[2]
Stage 0 Tis N0 M0 Tis: Tumor confined to mucosa; cancer-in-situ
Stage I T1 N0 M0 T1: Tumor invades submucosa
T2 N0 M0 T2: Tumor invades muscularis propria
Stage II-A T3 N0 M0 T3: Tumor invades subserosa or beyond (without other organs involved)
Stage II-B T4a N0 M0 T4a: Tumor perforates the visceral peritoneum
Stage II-C T4b N0 M0 T4b: Tumor invades adjacent organs
Stage III-A
  • T1-2 N1 M0 or
  • T1, N2a, M0
  • N1: Tumor cells in 1 to 3 regional lymph nodes. T1 or T2.
  • N2a: Tumor cells in 4 to 6 regional lymph nodes. T1
Stage III-B
  • T3-4a, N1 M0 or
  • T2-3, N2a, M0 or
  • T1-2 N2b M0
  • N1: Tumor cells in 1 to 3 regional lymph nodes. T3 or T4
  • N2a: Tumor cells in 4 to 6 regional lymph nodes. T2 or T3
  • N2b: Tumor cells in 7 or more regional lymph nodes. T1 or 2
Stage III-C
  • T4a N2a M0 or
  • T3-4a N2b M0 or
  • T4b N1-2, M0
  • N2a: Tumor cells in 4 to 6 regional lymph nodes. T4a
  • N2b: Tumor cells in 7 or more regional lymph nodes. T3-4a
  • N1-2: Tumor cells in at least one regional lymph node. T4b
Stage IVa any T, any N, M1a M1a: Metastasis to 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N.
Stage IVb any T, any N, M1b M1b: Metastasis to more than 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N.
Stage IVc any T, any N, M1c M1c: Metastasis to the peritoneal surface. Any T, any N.

Microscopy report

It should include:[1]

  • Tumor type[1]
  • Degree of differentiation[1]
  • Depth of growth and/or infiltration
  • Whether the resection is radical
  • Any breakthrough of the serosa and/or resection margin
  • Number of lymph nodes found
  • Number of them with metastases
  • Number of them with periglandular growth

  See also: General notes on reporting


Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Unless otherwise specified, refereence is: Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  2. ↑ 2.0 2.1 2.2 . Colorectal Cancer: Stages. Cancer.net (American Society of Clinical Oncology). Retrieved on 2019-09-26. Approved by the Cancer.Net Editorial Board, 11/2018. In turn citing:
    Amin, Mahul B.; Greene, Frederick L.; Edge, Stephen B.; Compton, Carolyn C.; Gershenwald, Jeffrey E.; Brookland, Robert K.; Meyer, Laura; Gress, Donna M.; et al. (2017). "The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging ". CA: A Cancer Journal for Clinicians 67 (2): 93–99. doi:10.3322/caac.21388. ISSN 00079235. 

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