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Procedure A word about when to use this protocol

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A word about when to use this protocol

From the CAP cancer protocol, note A

Pancreaticoduodenectomy (Whipple resection) Segmental resection of bile ducts(s) Choledochal cyst resection Other Not specified

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Tumor Site

Common bile duct, Extrapancreatic Common bile duct, Intrapancreatic Other Not specified

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Tumor Size (cm)

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Histologic Type

Adenocarcinoma, intestinal type Adenocarcinoma, biliary type Mucinous adenocarcinoma Clear cell adenocarcinoma Signet-ring cell carcinoma Adenosquamous carcinoma Mucinous cystic neoplasm with an associated invasive carcinoma Squamous cell carcinoma Undifferentiated carcinoma Mixed neuroendocrine-non-neuroendocrine tumor carcinoma Large cell neuroendocrine carcinoma Small cell neuroendocrine carcinoma Other histologic type Carcinoma, type cannot be determined

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Histologic Grade

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

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Tumor Extension

No invasion (carcinoma in situ/high-grade dysplasia) Tumor confined to the bile duct histologically Tumor invades beyond the wall of the bile duct Tumor invades the duodenum Tumor involves posterior surface of pancreas Tumor involves anterior surface of pancreas Tumor involves pancreatic portal vein vascular bed/groove Tumor invades the gallbladder Tumor invades other adjacent structures Cannot be assessed

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Depth of Tumor Extension

No invasion (carcinoma in situ/high-grade dysplasia only) Tumor invades with a depth <5 mm Tumor invades with a depth of 5-12 mm Tumor invades with a depth >12 mm Cannot be determined

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Margins

All margins are uninvolved by invasive carcinoma and high-grade intraepithelial neoplasia One or more margins involved by neoplasia

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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 cannot be assessed pTis: Carcinoma in situ/high-grade dysplasia pT1: Tumor invades the bile duct wall with a depth less than 5 mm pT2: Tumor invades the bile duct wall with a depth of 5-12 mm pT3: Tumor invades the bile duct wall with a depth greater than 12 mm pT4: Tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic arter

pN

pNX: Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis pN1: Metastasis in one to three regional lymph nodes pN2: Metastasis in four or more regional lymph nodes

pM

pMx: Not applicable pM1: Distant metastasis

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+ Additional Pathologic Findings

None identified Choledochal cyst Dysplasia Primary sclerosing cholangitis (PSC) Biliary stones Other