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Note: This can be used for EMR and resection cancer synoptics, based on the procedure performed.

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Procedure

Abdominoperineal resection Excisional biopsy (polypectomy) Local (transanal disk) excision Other Not specified

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Tumor Site

Anal canal Perianal region Anus, not otherwise specified Unknown Other

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Tumor Size (cm)

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Histologic Type

Squamous cell carcinoma Verrucous carcinoma Adenocarcinoma Large cell neuroendocrine carcinoma Small cell neuroendocrine carcinoma Mixed adenoneuroendocrine non-neuroendocrine neoplasm Other histologic type

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Histologic Grade

G1: Well differentiated G2: Moderately differentiated G3: Poorly differentiated G4: Undifferentiated Other GX: Cannot be assessed Not applicable

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Tumor Extension

No evidence of primary tumor Carcinoma in situ Tumor invades lamina propria Tumor invades muscularis mucosae Tumor invades submucosa Tumor invades into but not through anal sphincter muscle Tumor invades into but not through muscularis propria of rectum Tumor invades through anal sphincter muscle into perianal or perirectal soft tissue without involvement of adjacent structures Tumor directly invades adjacent structures Tumor invades perianal skin

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Margins

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Treatment Effect A word about scoring treatment effect

×

A word about scoring treatment effect

No known presurgical therapy Present, complete response, score 0 Present, near complete response, score 1 Present, partial response, score 2 Absent, poor or no response, score 3 Cannot be determined

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+ Lymphovascular Invasion

Not identified Present Cannot be determined

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+ Perineural Invasion

Not identified Present Cannot be determined

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Regional Lymph Nodes

Check here if any lymph nodes submitted?

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Pathologic Staging (pTNM)

TNM Descriptors (select all that apply)

Not applicable m r y

pT

pTX: Primary tumor not assessed pT0: No evidence of primary tumor pTis: High-grade squamous intraepithelial lesion pT1: Tumor ≤2 cm pT2: Tumor >2 cm but ≤5 cm pT3: Tumor >5 cm pT4: Tumor of any size invading adjacent organ(s)

pN

pNX: Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis pN1a: Metastasis in inguinal, mesorectal, or internal iliac lymph nodes pN1b: Metastasis in external iliac lymph nodes pN1c: Metastasis in external iliac with any N1a nodes

pM

pMx: Not applicable pM1: Distant metastasis

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+ Additional Pathologic Findings

None identified Crohn disease Condyloma acuminatum Anal fistula Dysplasia Associated rectal carcinoma (Paget disease) Other