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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 Perihilar Cancer protocol - Note A

Segmental resection of bile ducts(s) Hilar and/or partial hepatic resection Choledochal cyst resection Total hepatectomy Other Not specified

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Tumor Site

Right hepatic duct Left hepatic duct Junction of right and left hepatic ducts Cystic duct Common hepatic duct Common bile duct 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 Not applicable

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Tumor Extension

No invasion (carcinoma in situ/high-grade dysplasia) Tumor confined to the bile duct Tumor invades beyond the wall of the bile duct into surrounding connective tissue Tumor invades the adjacent liver parenchyma Tumor invades the gallbladder Tumor invades the unilateral branches of the portal vein (right or left) Tumor invades the unilateral branches of the hepatic artery (right or left) Tumor invades main portal vein or its branches bilaterally Tumor invades common hepatic artery Tumor invades second-order biliary radicals, unilateral Tumor invades second-order biliary radicals, bilateral Cannot be assessed

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Radial Margin

Cannot be assessed Uninvolved by invasive carcinoma Involved by invasive carcinoma

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Other Margin

Not applicable Cannot be assessed Uninvolved by invasive carcinoma Involved by invasive carcinoma

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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 pT0: No evidence of primary tumor pTis: Carcinoma in situ/high-grade dysplasia pT1: Tumor confined to the bile duct, with extension up to the muscle layer or fibrous tissue pT2: Tumor invades beyond the wall of the bile duct to surrounding adipose tissue, or tumor invades adjacent hepatic parenchyma pT2a: Tumor invades beyond the wall of the bile duct to surrounding adipose tissue pT2b: Tumor invades adjacent hepatic parenchyma pT3: Tumor invades unilateral branches of the portal vein or hepatic artery pT4: Tumor invades the main portal vein or its branches bilaterally pT4: Tumor invades the common hepatic artery pT4: Tumor invades unilateral second-order biliary radicals with contralateral portal vein pT4: Hepatic artery involvement

pN

pNX: Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis pN1: One to three positive regional lymph nodes pN2: Four or more positive lymph nodes from the sites described for N1

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