Protocol for the Examination of Specimens From Patients With Primary Carcinoma of the Colon and Rectum

Abstract

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.This protocol applies to all primary carcinomas of the colon and rectum. Well-differentiated neuroendocrine neoplasms (carcinoid tumors) are not included. The seventh edition TNM staging system for carcinoma of the colon and rectum of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) is recommended.Select a Single Response Unless Otherwise Indicated* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.Tumor Site (note A)__ Cecum__ Right (ascending) colon__ Hepatic flexure__ Transverse colon__ Splenic flexure__ Left (descending) colon__ Sigmoid colon__ Rectum__ Other (specify): ______ Not specified*Specimen Integrity*__ Intact*__ Fragmented*Polyp Size* Greatest dimension: __ cm* Additional dimensions: __ × __ cm*__ Cannot be determined (see Comment)*Polyp Configuration*__ Pedunculated with stalk * Stalk length: __ cm*__ SessileSize of Invasive CarcinomaGreatest dimension: __ cm* Additional dimensions: __ × __ cm__ Cannot be determined (see Comment)Histologic Type (note B)__ Adenocarcinoma__ Mucinous adenocarcinoma__ Signet-ring cell carcinoma__ Small cell carcinoma__ Squamous cell carcinoma__ Adenosquamous carcinoma__ Medullary carcinoma__ Undifferentiated carcinoma__ Other (specify): ______ Carcinoma, type cannot be determinedHistologic Grade (note C)__ Not applicable__ Cannot be determined__ Low grade (well differentiated to moderately differentiated)__ High grade (poorly differentiated to undifferentiated)Microscopic Tumor Extension (note D)__ Cannot be determinedInvasion (deepest): __ Lamina propria __ Muscularis mucosae __ Submucosa __ Muscularis propriaMargins (select all that apply)Deep Margin (Stalk Margin)__ Cannot be assessed__ Uninvolved by invasive carcinoma Distance of invasive carcinoma from margin: __ mm__ Involved by invasive carcinomaMucosal/Lateral Margin__ Not applicable__ Cannot be assessed__ Uninvolved by invasive carcinoma__ Involved by invasive carcinoma__ Involved by adenomaLymph-Vascular Invasion (notes D and E)__ Not identified__ Present__ Indeterminate*Type of Polyp in Which Invasive Carcinoma Arose (note F)*__ Tubular adenoma*__ Villous adenoma*__ Tubulovillous adenoma*__ Traditional serrated adenoma*__ Sessile serrated adenoma*__ Hamartomatous polyp*__ Indeterminate*Additional Pathologic Findings (select all that apply)*__ None identified*__ Inflammatory bowel disease *__ Active *__ Quiescent*__ Other (specify): ____*Ancillary Studies* Specify: ____*__ Not performed*Comment(s): ____Select a Single Response Unless Otherwise Indicated* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.Specimen (select all that apply) (note A)__ Terminal ileum__ Cecum__ Appendix__ Ascending colon__ Transverse colon__ Descending colon__ Sigmoid colon__ Rectum__ Anus__ Other (specify): ______ Not specifiedProcedure__ Right hemicolectomy__ Transverse colectomy__ Left hemicolectomy__ Sigmoidectomy__ Rectal/rectosigmoid colon (low anterior resection)__ Total abdominal colectomy__ Abdominoperineal resection__ Transanal disk excision (local excision)__ Other (specify): ______ Not specified*Specimen Length (if applicable)* Specify: __ cmTumor Site (select all that apply) (note A)__ Cecum__ Right (ascending) colon__ Hepatic flexure__ Transverse colon__ Splenic flexure__ Left (descending) colon__ Sigmoid colon__ Rectosigmoid__ Rectu