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AP CP initial decks from RD > Staging > Flashcards

Staging Flashcards

1
Q

PROSTATE

Primary Tumor (pT)

___ Not identified

___ pT2:

+ ___ pT2a:

+ ___ pT2b:

+ ___ pT2c:

pT3:

___ pT3a:

___ pT3b:

___ pT4:

Regional Lymph Nodes (pN)

___ pNX:

___ pN0:

___ pN1:

Distant Metastasis (pM)

___ Not applicable

___ pM1:

___ pM1a:

___ pM1b:

___ pM1c:

A

PROSTATE

Primary Tumor (pT)

___ Not identified

___ pT2: Organ confined

+ ___ pT2a: Unilateral, involving one-half of 1 side or less

+ ___ pT2b: Unilateral, involving more than one-half of 1 side but not both sides

+ ___ pT2c: Bilateral disease

pT3: Extraprostatic extension

___ pT3a: Extraprostatic extension or microscopic invasion of bladder neck

___ pT3b: Seminal vesicle invasion

___ pT4: Invasion of rectum, levator muscles and/or pelvic wall (Note J)

Note: There is no pathologic T1 classification. Subdivision of pT2 disease is problematic and has not proven to be of prognostic significance.

Regional Lymph Nodes (pN)

___ pNX: Cannot be assessed

___ pN0: No regional lymph node metastasis

___ pN1: Metastasis in regional lymph node or nodes

Distant Metastasis (pM)

___ Not applicable

___ pM1: Distant metastasis

___ pM1a: Nonregional lymph nodes(s)

___ pM1b: Bone(s)

___ pM1c: Other site(s) with or without bone disease

Note: When more than 1 site of metastasis is present, the most advanced category is used. pM1c is most advanced.

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2
Q

Prostate Staging

A

Prostate Staging

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3
Q

BLADDER

Primary Tumor (pT)

___ pTX:

___ pT0:

___ pTa:

___ pTis:

___ pT1:

pT2:

___ pT2a:

___ pT2b:

pT3:

___ pT3a:

___ pT3b:

pT4:

___ pT4a:

___ pT4b:

Regional Lymph Nodes (pN)

___ pNX:

___ pN0:

___ pN1:

___ pN2:

___ pN3:

Distant Metastasis (pM)

___ Not applicable

___ pM1:

A

BLADDER

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pTa: Noninvasive papillary carcinoma

___ pTis: Carcinoma in situ: “flat tumor”

___ pT1: Tumor invades subepithelial connective tissue (lamina propria)

pT2: Tumor invades muscularis propria (detrusor muscle)

___ pT2a: Tumor invades superficial muscularis propria (inner half)

___ pT2b: Tumor invades deep muscularis propria (outer half)

pT3: Tumor invades perivesical tissue

___ pT3a: Microscopically

___ pT3b: Macroscopically (extravesicular mass)

pT4: Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall

___ pT4a: Tumor invades prostatic stroma or uterus or vagina

___ pT4b: Tumor invades pelvic wall or abdominal wall

Regional Lymph Nodes (pN)

___ pNX: Lymph nodes cannot be assessed

___ pN0: No lymph node metastasis

___ pN1: Single regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac or presacral lymph node)

___ pN2: Multiple regional lymph node metastasis in the true pelvis (hypogastric, obrutrator, external iliac or presacral lymph node metastasis)

___ pN3: Lymph node metastasis to the common iliac lymph nodes

Distant Metastasis (pM)

___ Not applicable

___ pM1: Distant metastasis

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4
Q
A
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5
Q

Bladder Staging

A

Bladder Staging

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6
Q

Histologic Grade (Fuhrman Nuclear Grade)

  • GX:
  • G1:
  • G2:
  • G3:
  • G4:

Primary Tumor (pT)

  • pTX:
  • pT0:
  • pT1:
    • pT1a:
    • pT1b:
  • pT2:
    • pT2a:
    • pT2b:
  • pT3:
    • pT3a:
    • pT3b:
    • pT3c:
  • pT4:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1:

Distant Metastasis (pM)

  • Not applicable
  • pM1:
A

Histologic Grade (Fuhrman Nuclear Grade)

  • Not applicable
  • GX: Cannot be assessed
  • G1: Nuclei round, uniform, approximately 10 µm; nucleoli inconspicuous or absent
  • G2: Nuclei slightly irregular, approximately 15 µm; nucleoli evident
  • G3: Nuclei very irregular, approximately 20 µm; nucleoli large and prominent
  • G4: Nuclei bizarre and multilobated, 20 µm or greater, nucleoli prominent, chromatin clumped

Primary Tumor (pT)

  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor
  • pT1: Tumor 7 cm or less in greatest dimension, limited to the kidney
    • pT1a: Tumor 4 cm or less in greatest dimension, limited to the kidney
    • pT1b: Tumor more than 4 cm but not more than 7 cm in greatest dimension, limited to the kidney
  • pT2: Tumor more than 7 cm in greatest dimension, limited to the kidney
    • pT2a: Tumor more than 7 cm but less than or equal to 10 cm in greatest dimension, limited to the kidney
    • pT2b: Tumor more than 10 cm, limited to the kidney
  • pT3: Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia
    • pT3a: Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota’s fascia
    • pT3b: Tumor grossly extends into the vena cava below the diaphragm
    • pT3c: Tumor grossly extends into vena cava above diaphragm or invades the wall of the vena cava
  • pT4: Tumor invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)

Regional Lymph Nodes (pN)

  • pNX: Regional lymph nodes cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Metastasis in regional lymph node(s)

Distant Metastasis (pM)

  • Not applicable
  • pM1: Distant metastasis
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7
Q
A
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8
Q

Kidney Staging

A

Kidney Staging

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9
Q

Breast

Primary Tumor (Invasive Carcinoma) (pT)

  • pTX:
  • pT0:
  • pTis (DCIS):
  • pTis (LCIS):
  • pTis (Paget):
  • pT1:
    • pT1mi:
    • pT1a:
    • pT1b:
    • pT1c:
  • pT2:
  • pT3:
  • pT4:
    • pT4a:
    • pT4b:
    • pT4c:
    • pT4d:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
    • pN0 (i-):
    • pN0 (i+):
    • pN0 (mol-):
    • pN0 (mol+):
  • pN1mi:
  • pN1a:
  • pN2a:
  • pN3a: .

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

  • pM1:
A

Primary Tumor (Invasive Carcinoma) (pT)

  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor#
  • pTis (DCIS): Ductal carcinoma in situ#
  • pTis (LCIS): Lobular carcinoma in situ#
  • pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/or carcinoma in situ (DCIS and/or LCIS) in the underlying breast parenchyma#
  • pT1: Tumor ≤20 mm in greatest dimension
    • pT1mi: Tumor ≤1 mm in greatest dimension (microinvasion)
    • pT1a: Tumor >1 mm but ≤5 mm in greatest dimension
    • pT1b: Tumor >5 mm but ≤10 mm in greatest dimension
    • pT1c: Tumor >10 mm but ≤20 mm in greatest dimension
  • pT2: Tumor >20 mm but ≤50 mm in greatest dimension
  • pT3: Tumor >50 mm in greatest dimension
  • pT4: Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules). Note: Invasion of the dermis alone does not qualify as pT4.
    • pT4a: Extension to chest wall, not including only pectoralis muscle adherence/invasion
    • pT4b: Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin which do not meet the criteria for inflammatory carcinoma
    • pT4c: Both T4a and T4b
    • pT4d: Inflammatory carcinoma

Regional Lymph Nodes (pN)

  • pNX: Regional lymph nodes cannot be assessed (eg, previously removed, or not removed for pathologic study)
  • pN0: No regional lymph node metastasis identified histologically
    • pN0 (i-): No regional lymph node metastases histologically, negative IHC
    • pN0 (i+): Malignant cells in regional lymph node(s) no greater than 0.2 mm and no more than 200 cells (detected by H&E or IHC including ITC)
    • pN0 (mol-): No regional lymph node metastases histologically, negative molecular findings (reverse transcriptase polymerase chain reaction [RT-PCR])
    • pN0 (mol+): Positive molecular findings (RT-PCR), but no regional lymph node metastases detected by histology or IHC
  • pN1mi: Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm).
  • pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis greater than 2.0 mm#
  • pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm)#
  • pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm)#

Nodes containing only ITCs are excluded from the total positive node count for purposes of N classification but should be included in the total number of nodes evaluated.

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

  • pM1: Distant detectable metastasis as histologically proven larger than 0.2 mm
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10
Q

Breast Staging

A

Breast Staging

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11
Q

Cervix

Cervix

Histologic Grade

  • Not applicable
  • GX:
  • G1:
  • G2:
  • G3:

Primary Tumor (pT)

  • pTX:
  • pT1:
    • pT1a:
      • pT1a1:
      • pT1a2:
    • pT1b:
      • pT1b1:
      • pT1b2:
  • pT2:
    • pT2a:
      • pT2a1:
      • pT2a2:
    • pT2b:
  • pT3:
    • pT3a:
    • pT3b:
  • pT4:

Regional Lymph Nodes (pN) (select all that apply)

  • pNX:
  • pN0:
  • pN1:

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

  • pM1:
A

Cervix

Histologic Grade

  • Not applicable
  • GX: Cannot be assessed
  • G1: Well differentiated
  • G2: Moderately differentiated
  • G3: Poorly differentiated

Primary Tumor (pT)

  • pTX: Cannot be assessed
  • pT1: Cervical carcinoma confined to uterus (extension to corpus should be disregarded)
    • pT1a: Invasive carcinoma diagnosed by microscopy only. All macroscopically visible lesions (even with superficial invasion) are pT1b/1B.
      • pT1a1: Stromal invasion ≤3.0 mm in depth and horizontal spread ≤7.0 mm
      • pT1a2: Stromal invasion >3.0 mm but not more than 5.0 mm in depth and horizontal spread ≤7.0 mm
    • pT1b: Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a2/IA2
      • pT1b1: Clinically visible lesion ≤4.0 cm in greatest dimension
      • pT1b2: Clinically visible lesion >4.0 cm in greatest dimension
  • pT2: Tumor invades beyond the uterus but not to pelvic wall or to lower third of vagina
    • pT2a: Tumor without parametrial invasion
      • pT2a1: Clinically visible lesion ≤4.0 cm in greatest dimension
      • pT2a2: Clinically visible lesion >4.0 cm in greatest dimension
    • pT2b: Tumor with parametrial invasion
  • pT3: Tumor extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or nonfunctioning kidney
    • pT3a: Tumor involves lower third of vagina, but not pelvic wall
    • pT3b: Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney
  • pT4: Tumor invades the mucosa of bladder or rectum and/or extends beyond true pelvis (bullous edema is not sufficient evidence to classify a tumor as pT4)

Regional Lymph Nodes (pN) (select all that apply)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Regional lymph node metastasis

+ Number of lymph nodes with isolated tumor cells (<0.2 mm):
+ Number of lymph nodes with micrometastasis (>0.2 mm to 2 mm):

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

  • pM1: Distant metastasis
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12
Q

Cervix

FIGO Stage

  • I:
    • IA:
      • IA1:
      • IA2:
    • IB:
      • IB1:
      • IB2:
  • II:
    • IIA:
      • IIA1:
      • IIA2:
    • IIB:
  • III:
    • IIIA:
    • IIIB:
  • IV:
    • IVA:
    • IVB:
A

Cervix

FIGO Stage

  • I: Carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded).
    • IA: Invasive cancer identified only microscopically. (All gross lesions even with superficial invasion are stage IB cancers.) Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm.
      • IA1: Measured invasion of stroma ≤3 mm in depth and ≤7 mm width.
      • IA2: Measured invasion of stroma >3 mm and <5 mm in depth and ≤7 mm width.
    • IB: Clinical lesions confined to the cervix, or preclinical lesions greater than stage IA.
      • IB1: Clinical lesions ≤4 cm in size.
      • IB2: Clinical lesions >4cm in size.
  • II: The carcinoma extends beyond the uterus, but has not extended onto the pelvic wall or to the lower third of vagina.
    • IIA: Involvement of up to the upper two-thirds of the vagina. No obvious parametrial involvement.
      • IIA1: Clinically visible lesion ≤4 cm
      • IIA2: Clinically visible lesion >4 cm
    • IIB: Obvious parametrial involvement but not onto the pelvic sidewall.
  • III: The carcinoma has extended onto the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumor and pelvic sidewall. The tumor involves the lower third of the vagina. All cases of hydronephrosis or nonfunctioning kidney should be included unless they are known to be due to other causes.
    • IIIA: Involvement of the lower vagina but no extension onto pelvic sidewall.
    • IIIB: Extension onto the pelvic sidewall, or hydronephrosis/nonfunctioning kidney.
  • IV: Carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.
    • IVA: Spread to adjacent pelvic organs.
    • IVB: Spread to distant organs.

Note: The depth of invasion should not be more than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space invasion should not alter the staging.

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13
Q

Colon

Primary Tumor (pT)

  • pTX:
  • pT0:
  • pTis:
  • pTis:
  • pT1:
  • pT2:
  • pT3:
  • pT4
    • pT4a:
    • pT4b:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1
    • pN1a:
    • pN1b:
    • pN1c:
  • pN2
    • pN2a:
    • pN2b:

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

  • pM1: Distant metastasis
    • pM1a: Metastasis to single organ or site (eg, liver, lung, ovary, nonregional lymph node)
    • pM1b: Metastasis to more than 1 organ/site or to the peritoneum
A

Colon

Primary Tumor (pT)

  • pTX: Cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Carcinoma in situ, intraepithelial (no invasion of lamina propria)
  • pTis: Carcinoma in situ, invasion of lamina propria/muscularis mucosae
  • pT1: Tumor invades submucosa
  • pT2: Tumor invades muscularis propria
  • pT3: Tumor invades through the muscularis propria into pericolorectal tissues
  • pT4
    • pT4a: Tumor penetrates the visceral peritoneum
    • pT4b: Tumor directly invades or is adherent to other organs or structures

Regional Lymph Nodes (pN)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1
    • pN1a: Metastasis in 1 regional lymph node
    • pN1b: Metastasis in 2 to 3 regional lymph nodes
    • pN1c: Tumor deposit(s) in the subserosa, or non-peritonealized pericolic or perirectal tissues without regional lymph node metastasis
  • pN2
    • pN2a: Metastasis in 4 to 6 regional lymph nodes
    • pN2b: Metastasis in 7 or more regional lymph nodes

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

  • pM1: Distant metastasis
    • pM1a: Metastasis to single organ or site (eg, liver, lung, ovary, nonregional lymph node)
    • pM1b: Metastasis to more than 1 organ/site or to the peritoneum
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14
Q

Colon

A

Colon

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15
Q

Colon T4

A

Colon T4

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16
Q

Colon Staging

A

Colon Staging

17
Q

Endometrium

Primary Tumor (pT)

  • pTX:
  • pT0:
  • pT1
    • pT1a:
    • pT1b:
  • pT2:
  • pT3
    • pT3a:
    • pT3b:
  • pT4:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1:
  • pN2:

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

  • pM1:
A

Endometrium

Primary Tumor (pT)

  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor
  • pT1
    • pT1a: Tumor limited to endometrium or invades less than one-half of the myometrium
    • pT1b: Tumor invades greater than or equal to one-half of the myometrium
  • pT2: Tumor invades stromal connective tissue of the cervix, but does not extend beyond uterus
  • pT3
    • pT3a: Tumor involves serosa and/or adnexa (direct extension or metastasis)
    • pT3b: Vaginal involvement (direct extension or metastasis) or parametrial involvement
  • pT4: Tumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)

Regional Lymph Nodes (pN)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Regional lymph node metastasis to pelvic lymph nodes
  • pN2: Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes

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

  • pM1: Distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease, or lung, liver, or bone metastasis. It excludes metastasis to para-aortic lymph nodes, vagina, pelvic serosa, or adnexa)
18
Q

Endometrium

FIGO Stage

  • I:
    • IA:
    • IB:
  • II:
  • III:
    • IIIA:
    • IIIB:
    • IIIC:
      • IIIC1:
      • IIIC2:
  • IV:
    • IVA:
    • IVB:
A

Endometrium

FIGO Stage

  • I: Tumor confined to the corpus uteri
    • IA: No or less than half myometrial invasion
    • IB: Invasion equal to or more than half of the myometrium
  • II: Tumor invades cervical stroma, but does not extend beyond the uterus
  • III: Local and/or regional spread of the tumor
    • IIIA: Tumor invades the serosa of the corpus uteri and/or adnexae
    • IIIB: Vaginal involvement and/ or parametrial involvement
    • IIIC: Metastases to pelvic and/or para-aortic lymph nodes
      • IIIC1: Positive pelvic nodes
      • IIIC2: Positive para-aortic nodes with or without positive pelvic lymph nodes
  • IV: Tumor invades bladder and/or bowel mucosa, and/or distant metastases
    • IVA: Tumor invasion of bladder and/or bowel mucosa
    • IVB: Distant metastasis, including intraabdominal metastases and/or inguinal nodes
19
Q

Endometrium TNM Staging

A

Endometrium TNM Staging

20
Q

Esophagus

Primary Tumor (pT)

  • pTX:
  • pT0:
  • pTis:
  • pT1:
    • pT1a:
    • pT1b:
  • pT2:
  • pT3:
  • pT4:
    • pT4a:
    • pT4b:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1:
  • pN2:
  • pN3:

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

  • pM1:
A

Esophagus

Primary Tumor (pT)

  • pTX: Cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: High-grade dysplasia
  • pT1: Tumor invades lamina propria, muscularis mucosae, or submucosa
    • pT1a: Tumor invades lamina propria or muscularis mucosae
    • pT1b: Tumor invades submucosa
  • pT2: Tumor invades muscularis propria
  • pT3: Tumor invades adventitia
  • pT4: Tumor invades adjacent structures (specify):
    • pT4a: Resectable tumor invading pleura, pericardium, or diaphragm
    • pT4b: Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc

Regional Lymph Nodes (pN)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Regional lymph node metastasis involving 1 to 2 nodes
  • pN2: 3 to 6 nodes involved
  • pN3: 7 or more nodes involved

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

  • pM1: Distant metastasis
21
Q

Esophagus

A

Esophagus

22
Q

Esophagus Staging - Squamous Cell Carcinoma

A

Esophagus Staging - Squamous Cell Carcinoma

23
Q

Esophagus Staging - Adenocarcinoma

A

Esophagus Staging -

24
Q

Lung

Primary Tumor (pT)

  • pTX:
  • pT0:
  • pTis:
  • pT1
    • pT1a:
    • pT1b:
  • pT2
    • pT2a:
    • pT2b:
  • pT3:
  • pT4:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1:
  • pN2:
  • pN3:

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

  • pM1:
    • pM1a:
    • pM1b:
A

Lung

Primary Tumor (pT)

  • pTX: Cannot be assessed, or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
  • pT0: No evidence of primary tumor
  • pTis: Carcinoma in situ
  • pT1
    • pT1a: Tumor 2 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (ie, not in the main bronchus); or
      • Superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend proximally to the main bronchus
    • pT1b: Tumor greater than 2 cm, but 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (ie, not in the main bronchus)
  • pT2
    • pT2a: Tumor greater than 3 cm, but 5 cm or less in greatest dimension surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (ie, not in the main bronchus); or
      • Tumor 5 cm or less in greatest dimension with any of the following features of extent: involves main bronchus, 2 cm or more distal to the carina; invades the visceral pleura; associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
    • pT2b: Tumor greater than 5 cm, but 7 cm or less in greatest dimension
  • pT3: Tumor greater than 7 cm in greatest dimension; or
    • Tumor of any size that directly invades any of the following: parietal plural chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or
    • Tumor of any size in the main bronchus less than 2 cm distal to the carina but without involvement of the carina; or
    • Tumor of any size associated with atelectasis or obstructive pneumonitis of the entire lung; or
    • Tumors of any size with separate tumor nodule(s) in same lobe
  • pT4: Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina; or
    • Tumor of any size with separate tumor nodule(s) in a different lobe of ipsilateral lung

Regional Lymph Nodes (pN)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes, including involvement by direct extension
  • pN2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
  • pN3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

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

  • pM1: Distant metastasis
    • pM1a: Separate tumor nodule(s) in contralateral lung; tumor with pleural nodules or malignant pleural (or pericardial) effusion
    • pM1b: Distant metastases (in extrathoracic organs)
25
Q

Lung Staging

A

Lung Staging

26
Q

Ovary/Fallopian Tube

Primary Tumor (pT)

Ovary

  • pTX:
  • pT0:
  • pT1:
    • pT1a:
    • pT1b:
    • pT1c:
  • pT2:
    • pT2a:
    • pT2b:
    • pT2c:
  • pT3 and/or N1:
    • pT3a:
    • pT3b:
    • pT3c and/or N1:

Fallopian Tube

  • pTX:
  • pT0:
  • pTis:
  • pT1:
    • pT1a:
    • pT1b:
    • pT1c:
  • pT2:
    • pT2a:
    • pT2b:
    • pT2c:
  • pT3 and/or N1:
    • pT3a:
    • pT3b:
    • pT3c/N1:
    • Any T/Any N and M1:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1:
    • pN1a:
    • pN1b:

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

  • pM1:
A

Ovary/Fallopian Tube

Primary Tumor (pT)

Ovary

  • pTX: Cannot be assessed
  • pT0: No evidence of primary tumor
  • pT1: Tumor limited to ovaries (1 or both)
    • pT1a: Tumor limited to 1 ovary; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings
    • pT1b: Tumor limited to both ovaries; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings
    • pT1c: Tumor limited to 1 or both ovaries with any of the following: capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings
  • pT2: Tumor involves one or both ovaries with pelvic extension and/or implants
    • pT2a: Extension and/or implants on uterus and/or tube(s). No malignant cells in ascites or peritoneal washings
    • pT2b: Extension to other pelvic tissues. No malignant cells in ascites or peritoneal washings
    • pT2c: Pelvic extension and/or implants (T2a or T2b/IIA or IIB) with malignant cells in ascites or peritoneal washings
  • pT3 and/or N1: Tumor involves 1 or both ovaries with confirmed peritoneal metastasis outside the pelvis (including liver capsule metastasis and/or regional lymph node metastasis [N1])
    • pT3a: Microscopic peritoneal metastasis beyond pelvis (no macroscopic tumor)
    • pT3b: Macroscopic peritoneal metastasis beyond pelvis =<2 cm in greatest dimension
    • pT3c and/or N1: Peritoneal metastasis beyond pelvis >2 cm in greatest dimension and/or regional lymph node metastasis

Fallopian Tube

  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Tubal intraepithelial carcinoma (limited to tubal mucosa)
  • pT1: Tumor limited to fallopian tube(s)
    • pT1a: Tumor limited to 1 tube without penetrating the serosal surface; no ascites
    • pT1b: Tumor limited to both tubes without penetrating the serosal surface; no ascites
    • pT1c: Tumor limited to 1 or both tube(s) with extension into or through the tubal serosa; or with malignant cells in ascites or peritoneal washings
  • pT2: Tumor involves 1 or both tube(s) with pelvic extension
    • pT2a: Extension and/or metastasis to the uterus and/or ovaries
    • pT2b: Extension to other pelvic structures
    • pT2c: Pelvic extension (T2a or T2b/IIA or IIB) with malignant cells in ascites or peritoneal washings
  • pT3 and/or N1: Tumor involves 1 or both tube(s) with peritoneal implants outside the pelvis and/or regional lymph node metastasis
    • pT3a: Microscopic peritoneal metastasis beyond pelvis
    • pT3b: Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension
    • pT3c/N1: Peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension and/or regional lymph node metastasis
    • Any T/Any N and M1: Distant metastasis including presence of malignant cells in pleural fluid or parenchymal hepatic metastasis

Regional Lymph Nodes (pN) (select all that apply)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Regional lymph node metastasis
    • pN1a: Lymph node metastasis up to 10 mm in greatest dimension
    • pN1b: Lymph node metastasis greater than 10 mm in greatest dimension

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

  • pM1: Distant metastases (excludes peritoneal metastasis)

Note: If pleural effusion is present, there must be a positive cytology for a stage IV designation. Parenchymal liver metastasis is classified as stage IV disease, whereas liver capsule metastasis is classified as stage III disease.

27
Q

Ovary/Fallopian Tube

FIGO Stage

  • I:
    • IA:
    • IB:
    • IC :
      • IC1:
      • IC2:
      • IC3:
  • II:
    • IIA:
    • IIB:
  • III:
    • IIIA:
      • IIIA1:
        • IIIA1(i):
        • IIIA1(ii):
      • IIIA2:
    • IIIB:
    • IIIC:
  • IV:
    • IVA:
    • IVB:
A

Ovary/Fallopian Tube

FIGO Stage

  • I: Tumor confined to ovaries or fallopian tube(s)
    • IA: Tumor limited to 1 ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings
    • IB: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings
    • IC Tumor limited to 1 or both ovaries or fallopian tubes, with any of the following:
      • IC1: Surgical spill intraoperatively
      • IC2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
      • IC3: Malignant cells present in the ascites or peritoneal washings
  • II: Tumor involves 1 or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer
    • IIA: Extension and/or implants on the uterus and/or fallopian tubes and/or ovaries
    • IIB: Extension to other pelvic intraperitoneal tissues
  • III: Tumor involves 1 or both ovaries, or fallopian tubes, or primary peritoneal cancer, with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes
    • IIIA: Metastasis to the retroperitoneal lymph nodes with or without microscopic peritoneal involvement beyond the pelvis
      • IIIA1: Positive retroperitoneal lymph nodes only (cytologically or histologically proven)
        • IIIA1(i): Metastasis ≤10 mm in greatest dimension#
        • IIIA1(ii): Metastasis >10 mm in greatest dimension#
      • IIIA2: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
    • IIIB: Macroscopic peritoneal metastases beyond the pelvic brim ≤2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes
    • IIIC: Macroscopic peritoneal metastases beyond the pelvic brim >2 cm in greatest dimension, with or without metastases to the retroperitoneal nodes##
  • IV: Distant metastasis excluding peritoneal metastases
    • IVA: Pleural effusion with positive cytology
    • IVB: Metastases to extraabdominal organs (including inguinal lymph nodes and lymph nodes outside of abdominal cavity)###
This is tumor dimension and not lymph node dimension.
## Includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ.
### Parenchymal metastases are stage IVB. Disease invading through the bowel wall and into the mucosa increases the stage to IVB, and transmural involvement of a visceral structure also represents stage IVB disease.
28
Q

Pancreas

Primary Tumor (pT)

  • pTX:
  • pT0:
  • pTis:
  • pT1:
  • pT2:
  • pT3:
  • pT4:

Regional Lymph Nodes (pN)

  • pNX:
  • pN0:
  • pN1:

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

  • pM1:
A

Pancreas

Primary Tumor (pT)

  • pTX: Cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Carcinoma in situ
  • pT1: Tumor limited to the pancreas, 2 cm or less in greatest dimension
  • pT2: Tumor limited to the pancreas, more than 2 cm in greatest dimension
  • pT3: Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
  • pT4: Tumor involves the celiac axis or the superior mesenteric artery

Regional Lymph Nodes (pN)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Regional lymph node metastasis

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

  • pM1: Distant metastasis
29
Q

Pancreas Staging

A

Pancreas Staging

30
Q

3 sites where vascular invasion changes pT stage?

A

Vascular invasion changes pT stage: HCC, Testis, Penis

HCC

  • T0 No evidence of primary tumor
  • T1 Solitary tumor without vascular invasion
  • T2 Solitary tumor with vascular invasion; or multiple tumors, none more than 5 cm in greatest dimension
  • T3 Multiple tumors more than 5 cm in greatest dimension or tumor involving a major branch of the portal or hepatic veins(s)
    • T3a Multiple tumors more than 5 cm
    • T3b Tumor(s) any size involving a major branch of the portal or hepatic vein(s)
  • T4 Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum

Testis

  • pTX: Cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Intratubular germ cell neoplasia (carcinoma in situ)
  • pT1: Tumor limited to the testis and epididymis without vascular/lymphatic invasion; tumor may invade tunica albuginea but not tunica vaginalis
  • pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
  • pT3: Tumor invades the spermatic cord with or without vascular/lymphatic invasion
  • pT4: Tumor invades the scrotum with or without vascular/lymphatic invasion

Penis

  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Carcinoma in situ
  • pTa: Noninvasive verrucous carcinoma#
  • pT1:
    • pT1a: Tumor invades subepithelial connective tissue without lymph vascular invasion and is not poorly differentiated (ie, grade 3-4)
    • pT1b: Tumor invades subepithelial connective tissue with lymph vascular invasion or is poorly differentiated
  • pT2: Tumor invades corpus spongiosum or cavernosum
  • pT3: Tumor invades urethra
  • pT4: Tumor invades other adjacent structures

Broad pushing penetration (invasion) is permitted, but destructive invasion argues against this diagnosis.

31
Q

HCC TNM

A

HCC

  • T0 No evidence of primary tumor
  • T1 Solitary tumor without vascular invasion
  • T2 Solitary tumor with vascular invasion; or multiple tumors, none more than 5 cm in greatest dimension
  • T3 Multiple tumors more than 5 cm in greatest dimension or tumor involving a major branch of the portal or hepatic veins(s)
  • T3a Multiple tumors more than 5 cm
  • T3b Tumor(s) any size involving a major branch of the portal or hepatic vein(s)
  • T4 Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum

Regional Lymph Nodes (N)

  • NX Regional lymph nodes cannot be assessed
  • N0 No regional lymph node metastasis
  • N1 Regional lymph node metastasis

Distant Metastasis (M)

  • M0 No distant metastasis
  • M1 Distant metastasis
32
Q

HCC Staging

A
33
Q

Testis pT

A

Testis

Primary Tumor (pT)

  • pTX: Cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Intratubular germ cell neoplasia (carcinoma in situ)
  • pT1: Tumor limited to the testis and epididymis without vascular/lymphatic invasion; tumor may invade tunica albuginea but not tunica vaginalis
  • pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
  • pT3: Tumor invades the spermatic cord with or without vascular/lymphatic invasion
  • pT4: Tumor invades the scrotum with or without vascular/lymphatic invasion

Regional Lymph Nodes (pN)

  • pNX: Cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Metastasis with a lymph node mass 2 cm or less in greatest dimension and less than or equal to 5 nodes positive, none more than 2 cm in greatest dimension
  • pN2: Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension of tumor
  • pN3: Metastasis with a lymph node mass more than 5 cm in greatest dimension

Distant Metastasis (pM)

  • Not applicable
  • pM1: Distant metastasis present
  • pM1a: Nonregional nodal or pulmonary metastasis
  • pM1b: Distant metastasis other than to nonregional lymph nodes and lung

Serum Tumor Markers (S) (Note G)

SX: Serum marker studies not available or performed

S0: Serum marker study levels within normal limits

LDH HCG (mIU/mL) AFP (ng/mL)

S1: <1.5 X N# and <5,000 and <1,000

S2: 1.5-10 X N or 5,000-50,000 or 1,000-10,000

S3: >10 X N or >50,000 or >10,000

34
Q

Testis Staging

A
35
Q

Penis TNM

A

Penis

Primary Tumor (pT)

  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor
  • pTis: Carcinoma in situ
  • pTa: Noninvasive verrucous carcinoma#
  • pT1:
    • pT1a: Tumor invades subepithelial connective tissue without lymph vascular invasion and is not poorly differentiated (ie, grade 3-4)
    • pT1b: Tumor invades subepithelial connective tissue with lymph vascular invasion or is poorly differentiated
  • pT2: Tumor invades corpus spongiosum or cavernosum
  • pT3: Tumor invades urethra
  • pT4: Tumor invades other adjacent structures

Broad pushing penetration (invasion) is permitted, but destructive invasion argues against this diagnosis.

Regional Lymph Nodes (pN)

  • pNX: Regional lymph nodes cannot be assessed
  • pN0: No regional lymph node metastasis
  • pN1: Metastasis in a single inguinal lymph node
  • pN2: Metastasis in multiple or bilateral inguinal lymph nodes
  • pN3: Extranodal extension of lymph node metastasis or pelvic lymph node(s) unilateral or bilateral

Distant Metastasis (pM)

  • Not applicable
  • pM1: Distant metastasis#

Lymph node metastasis outside of the true pelvis in addition to visceral or bone sites.

36
Q
A

+ Serum Tumor Markers (S) (Note G)

+ ___ SX: Serum marker studies not available or performed

+ ___ S0: Serum marker study levels within normal limits

LDH__HCG (mIU/mL)__AFP (ng/mL)

+ ___ S1: <1.5 X N# and <5,000 and <1,000

+ ___ S2: 1.5-10 X N or 5,000-50,000 or 1,000-10,000

+ ___ S3: >10 X N or >50,000 or >10,000

AP CP initial decks from RD (27 decks)

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