1.

DCIS Resection

Pathologic Stage Classification (pTNM, AJCC 8th Edition)(Note J)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1
line.Assignment of Pathologic Prognostic Stage Group is the responsibility of the managing physician and not the
pathologist.

TNM Descriptors (required only if applicable)

___ r (recurrent)

Primary Tumor (pT)

___ pTis (DCIS): Ductal carcinoma in situ

___ pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/orDCIS in
the underlying breast parenchyma#

Note: Paget disease with underlying DCIS is classified as Tis (DCIS).Encapsulated and solid papillary carcinomas without
conventional invasive carcinoma are staged as pTis (DCIS). If there has been a prior core needle biopsy, the pathologic
findings from the core, if available, should be incorporated in the T classification. If invasive carcinoma or microinvasion
were present on the core, the protocol for invasive carcinomas of the breast should be used and should incorporate this
information.

#
Note: Lobular carcinoma in situ (LCIS) is removed from TNM staging in the AJCC Cancer Staging Manual, 8th Edition.

Regional Lymph Nodes Modifier (required only if applicable)

___ (sn): Sentinel node(s) evaluated. If 6 or more nodes (sentinel or nonsentinel) are
removed, this modifier should not be used.

___ (f): Nodal metastasis confirmed by fine needle aspiration or core needle biopsy.

Note: The (sn) modifier is added to the N category when a sentinel node biopsy is performed (using either dye or tracer) and
fewer than six lymph nodes are removed (sentinel and nonsentinel). The (f) modifier is added to the N category to denote
confirmation of metastasis by fine needle aspiration/core needle biopsy with NO further resection of nodes.

Regional Lymph Nodes (pN) (choose a category if lymph nodes received with the specimen;
immunohistochemistry and/or molecular studies are not required)
___ pNX: Regional lymph nodes cannot be assessed (eg, not removed for pathological study
or previously removed)

___ pN0: No regional lymph node metastasis identified or ITCs only #

___ pN0 (i+): ITCs only (malignant cell clusters no larger than 0.2 mm) in regional lymph node(s)

___ pN0 (mol+): Positive molecular findings (RT-PCR), but no ITCs detected
___ pN1mi: Micrometastases (approximately 200 cells, larger than 0.2 mm, but none larger
than 2.0 mm)”

___ pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis larger than 2.0
mm##

___ pN1b: Metastases in ipsilateral internal mammary sentinel nodes, excluding ITCs

___ pN1c: pN1a and pN1b combined

___ pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit larger than 2.0
mm)##

___ pN2b: Metastases in clinically detected internal mammary lymph nodes with or without
microscopic confirmation; with pathologically negative axillary nodes

___ pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit larger
than 2.0 mm)##or metastases to the infraclavicular (Level III axillary lymph) nodes

___ pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by
imaging); or pN2a in the presence of pN1b

___ pN3c: Metastases in ipsilateral supraclavicular lymph nodes

#
Isolated tumor cells (ITCs) are defined as small clusters of cells not larger than 0.2 mm or single tumor cells, or a cluster of
fewer than 200 cells in a single histologic cross-section. ITCs may be detected by routine histology or by
immunohistochemical (IHC) methods. 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.

##
Approximately 1000 tumor cells are contained in a 3-dimensional 0.2-mm cluster.Thus, if more than 200 individual tumor
cells are identified as single dispersed tumor cells or as a nearly confluent elliptical or spherical focus in a single histologic
section of a lymph node, there is a high probability that more than 1000 cells are present in the lymph node.In these
situations, the node should be classified as containing a micrometastasis (pN1mi).Cells in different lymph node cross-
sections or longitudinal sections or levels of the block are not added together; the 200 cells must be in a single node profile
even if the node has been thinly sectioned into multiple slices.It is recognized that there is substantial overlap between the
upper limit of the ITC and the lower limit of the micrometastasis categories due to inherent limitations in pathologic nodal
evaluation and detection of minimal tumor burden in lymph nodes.Thus, the threshold of 200 cells in a single cross-section is
a guideline to help pathologists distinguish between these 2 categories.The pathologist should use judgment regarding
whether it is likely that the cluster of cells represents a true micrometastasis or is simply a small group of isolated tumor
cells.

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

___ pM1: Histologically proven metastases larger than 0.2 mm

Specify site, if known ____________________________

+ Specify report ID (if from a separate procedure) _______________________

Note: The presence of distant metastases in a case of DCIS would be very unusual. Additional sampling to identify
invasive carcinoma in the breast or additional history to document a prior or synchronous invasive carcinoma is
advised in the evaluation of such cases
 2. Breast Invasive Resection
Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note M)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.
Assignment of Pathologic Prognostic Stage Group is the responsibility of the managing physician and not the pathologist.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple foci of invasive carcinoma)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed ___ pT0: No evidence of primary tumor#

___ pTis (DCIS): Ductal carcinoma in situ#

___ pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/or DCIS in
the underlying breast parenchyma##

___ pT1: Tumor ≤20 mm in greatest dimension

___ pT1mi: Tumor ≤1 mm in greatest dimension

___ pT1a: Tumor >1 mm but ≤5 mm in greatest dimension (round any measurement
>1.0−1.9 mm to 2 mm)

___ 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) ###

___ pT4a: Extension to the chest wall; invasion or adherence to pectoralis muscle in the
absence of invasion of chest wall structures does not qualify as T4

___ pT4b: Ulceration and/or ipsilateral macroscopic satellite nodules and/or edema
(including peaud’orange) of the skin that does not meet the criteria for
inflammatory carcinoma

___ pT4c: Both T4a and T4b are present

___ pT4d: Inflammatory carcinoma####

#
For the purposes of this case summary, these categories should only be used in the setting of preoperative (neoadjuvant)
therapy for which a previously diagnosed invasive carcinoma is no longer present after treatment.Patients with pathological
complete response (absence of residual invasive carcinoma in both the breast and lymph nodes) should be categorized as
ypT0N0 or ypTisN0, not ypTX.

##
Carcinomas in the breast parenchyma associated with Paget disease are categorized based on the size and
characteristics of the parenchymal disease, although the presence of Paget disease should still be noted.
###
Note: Invasion of the dermis alone does not qualify as pT4.

####
Inflammatory carcinoma requires the presence of clinical findings of erythema and edema involving at least one-third or
more of the skin of the breast (see Note M).

Regional Lymph Nodes Modifier (required only if applicable)

___ (sn): Sentinel node(s) evaluated. If 6 or more nodes (sentinel or nonsentinel) are
removed, this modifier should not be used.

___ (f): Nodal metastasis confirmed by fine needle aspiration or core needle biopsy.

Note: The (sn) modifier is added to the N category when a sentinel node biopsy is performed (using either dye or tracer) and
fewer than six lymph nodes are removed (sentinel and nonsentinel). The (f) modifier is added to the N category to denote
confirmation of metastasis by fine needle aspiration/core needle biopsy with NO further resection of nodes.

Regional Lymph Nodes (pN) (choose a category based on lymph nodes received with the
specimen; immunohistochemistry and/or molecular studies are not required)
Note: If internal mammary lymph nodes, infraclavicular lymph nodes, or supraclavicular lymph nodes are included in the
specimen, consult the AJCC Staging Manual for additional lymph node categories.

___ pNX: Regional lymph nodes cannot be assessed (eg, not removed for pathological study
or previously removed)

___ pN0: No regional lymph node metastasis identified or ITCs only #

___ pN0 (i+): ITCs only (malignant cell clusters no larger than 0.2 mm) in regional lymph node(s)

___ pN0 (mol+): Positive molecular findings by reverse transcriptase polymerase chain reaction
(RT-PCR); no ITCs detected

___ pN1mi: Micrometastases (approximately 200 cells, larger than 0.2 mm, but none larger
than 2.0 mm)

___ pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis larger than 2.0
mm##

___ pN1b: Metastases in ipsilateral internal mammary sentinel nodes, excluding ITCs

___ pN1c: pN1a and pN1b combined

___ pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit larger than 2.0
mm)##
___ pN2b: Metastases in clinically detected internal mammary lymph nodes with or without
microscopic confirmation; with pathologically negative axillary nodes

___ pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit larger
than 2.0 mm) or metastases to the infraclavicular (Level III axillary lymph) nodes ##

___ pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by
imaging); or pN2a in the presence of pN1b

___ pN3c: Metastases in ipsilateral supraclavicular lymph nodes

#
Isolated tumor cells (ITCs) are defined as small clusters of cells not greater than 0.2 mm or single tumor cells, or a cluster
of fewer than 200 cells in a single histologic cross-section. ITCs may be detected by routine histology or by
immunohistochemical (IHC) methods. 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.

##
Approximately 1000 tumor cells are contained in a 3-dimensional 0.2-mm cluster. Thus, if more than 200 individual tumor
cells are identified as single dispersed tumor cells or as a nearly confluent elliptical or spherical focus in a single histologic
section of a lymph node, there is a high probability that more than 1000 cells are present in the lymph node. In these
situations, the node should be classified as containing a micrometastasis (pN1mi). Cells in different lymph node cross-
sections or longitudinal sections or levels of the block are not added together; the 200 cells must be in a single node profile
even if the node has been thinly sectioned into multiple slices. It is recognized that there is substantial overlap between the
upper limit of the ITC and the lower limit of the micrometastasis categories due to inherent limitations in pathologic nodal
evaluation and detection of minimal tumor burden in lymph nodes. Thus, the threshold of 200 cells in a single cross-section
is a guideline to help pathologists distinguish between these 2 categories. The pathologist should use judgment regarding
whether it is likely that the cluster of cells represents a true micrometastasis or is simply a small group of isolated tumor
cells.

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

___ pM1: Histologically proven metastases larger than 0.2 mm

Specify site, if known: ____________________

 3. Carcinoma Adrenal Gland
Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note G)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

Note: There is no category of carcinoma in situ (pTis) relative to carcinomas of the adrenal gland.

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor
___ pT1: Tumor ≤5 cm in greatest dimension, no extra-adrenal invasion
___ pT2: Tumor >5 cm, no extra-adrenal invasion
___ pT3: Tumor of any size with local invasion but not invading adjacent organs
___ pT4: Tumor of any size that invades adjacent organs (kidney, diaphragm, pancreas, spleen, or
liver) or large blood vessels (renal vein or vena cava)

Regional Lymph Nodes (pN) (Note H)

___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis

___ pN1: Metastasis in regional lymph node(s)

Distant Metastasis (pM) (Note I) (required only ifconfirmed pathologically in this case)
___ pM1: Distant metastasis

Specify site(s), if known: _______________________________

 4. Carcinoid tumors of Appendix
Pathologic Stage Classification(pTNM, AJCC 8th Edition) (Note F)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor 2 cm or less in greatest dimension

___ pT2: Tumor more than 2 cm but less than or equal to 4 cm

___ pT3: Tumor more than 4 cm or with subserosal invasion or involvement of the mesoappendix

___ pT4: Tumor perforates the peritoneum or directly invades other adjacent organs or structures
(excluding direct mural extension to adjacent subserosa of adjacent bowel), eg,
abdominal wall and skeletal muscle

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastasis

___ pN1: Regional lymph node metastasis

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

___ pM1: Distant metastasis

___ pM1a: Metastasis confined to liver

___ pM1b: Metastasis in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node,
peritoneum, bone)

___ pM1c: Both hepatic and extrahepatic metastases

Specify site(s), if known: __________________________

 5. Carcinoid of Colon and Rectum
Pathologic Stage Classification(pTNM, AJCC 8th Edition) (Note G)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)#

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor invades the lamina propria or submucosa and is ≤2 cm

___ pT1a: Tumor <1 cm in greatest dimension

___ pT1b: Tumor 1-2 cm in greatest dimension

___ pT2: Tumor invades the muscularis propria or is>2 cm with invasion of the lamina propria or
submucosa

___ pT3: Tumor invades through the muscularis propria into subserosal tissue without
penetration of overlying serosa

___ pT4: Tumor invades visceral peritoneum (serosa) or other organs or other adjacent structures
#
Note: For any T, add “(m)” for multiple tumors [TX(#) or TX(m), where X = 1–4 and # = number of primary tumors
identified##]; for multiple tumors with different T, use the highest.

##
Example: If there are two primary tumors, only one of which invades through the muscularis propria into the subserosal
tissue without penetration of the overlying serosa, we define the primary tumor as either T3(2) or T3(m) .

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastasis has occurred

___ pN1: Regional lymph node metastasis

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

___ pM1: Distant metastasis

___ pM1a: Metastasis confined to liver

___ pM1b: Metastasis in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node,
peritoneum, bone)

Specify site(s), if known: __________________________

___ pM1c: Both hepatic and extrahepatic metastases

Specify site(s), if known: __________________________

 6. Carcinoid tumor of duodenum and ampulla of vater
Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note H)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT1: Tumor invades the mucosa or submucosa only and is ≤1 cm (duodenal tumors); tumor ≤1
cm and confined within the sphincter of Oddi (ampullary tumors)

___ pT2: Tumor invades the muscularis propria or >1 cm (duodenal); tumor invades through
sphincter into duodenal submucosa or muscularis propria, or is>1 cm (ampullary)

___ pT3: Tumor invades the pancreas or peripancreatic adipose tissue

___ pT4: Tumor invades the visceral peritoneum (serosa) or other organs

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node involvement

___ pN1: Regional lymph node involvement

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

___ pM1: Distant metastasis

___pM1a: Metastasis confined to liver

___pM1b: Metastasis in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node,
peritoneum, bone)
 Specify site(s), if known: __________________________

___ pM1c: Both hepatic and extrahepatic metastases

Specify site(s), if known: __________________________

7. Carcinoid tumor of Jejunum and ileum

Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note G)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1#: Invades the lamina propria or submucosa and less than or equal to 1 cm in size

___ pT2#: Invades the muscularis propria or greater than 1 cm in size

___ pT3#: Invades through the muscularis propria into subserosal tissue without penetration of
overlying serosa

___ pT4#:Invades visceral peritoneum (serosal) or other organs or adjacent structures

#
Note: For any T, add (m) for multiple tumors [TX(#) or TX(m), where X = 1–4, and # = number of primary tumors
identified##]; for multiple tumors with different T, use the highest.

##
Example: If there are 2 primary tumors, only 1 of which invades through the muscularis propria into subserosal tissue
without penetration of overlying serosa (jejunal or ileal), we define the primary tumor as either T3(2) or T3(m) .
Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastasis has occurred

___ pN1: Regional lymph node metastasis less than 12 nodes

___ pN2: Large mesenteric masses (>2 cm) and/or extensive nodal deposits (12 or greater),
especially those that encase the superior mesenteric vessels

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

___ pM1: Distant metastasis

___ pM1a: Metastasis confined to liver

___ pM1b: Metastasis in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node,
peritoneum, bone)

Specify site(s), if known: __________________________

___ pM1c: Both hepatic and extrahepatic metastases

Specify site(s), if known: __________________________

8. Tumor of pancreas
Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note L)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the
pathologist at the time the report is issued. Only the applicable T, N, or M category is required for reporting; their
definitions need not be included in the report. The categories (with modifiers when applicable) can be listed on 1
line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Tumor cannot be assessed

___ pT1: Tumor limited to the pancreas#, <2 cm

___ pT2: Tumor limited to the pancreas#, 2-4 cm

___ pT3: Tumor limited to the pancreas#, >4 cm; or tumor invading the duodenum or common
bile duct

___ pT4: Tumor invading adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of
large vessels (celiac axis or the superior mesenteric artery)
#
Limited to the pancreas means there is no invasion of adjacent organs (stomach, spleen, colon, adrenal gland) or the wall
of large vessels (celiac axis or the superior mesenteric artery). Extension of tumor into peripancreatic adipose tissue is NOT a
basis for staging.

Note: Multiple tumors should be designated as such (the largest tumor should be used to assign T category).If the number
of tumors is known, use T(#); eg, pT3(4) N0 M0.If the number of tumors is unavailable or too numerous, use the m suffix,
T(m); eg, pT3(m) N0 M0.

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node involvement

___ pN1: Regional lymph node involvement

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

___ pM1: Distant metastasis

___ pM1a: Metastasis confined to liver

___ pM1b: Metastasis in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node,
peritoneum, bone)
Specify site(s), if known: ____________________________
___ pM1c: Both hepatic and extrahepatic metastases
Specify site(s), if known: ____________________________

9. Carcinoid tumor of Stomach

Pathologic Stage Classification(pTNM, AJCC 8th Edition) (Note G)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)
Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1#: Invades the lamina propria or submucosa and less than or equal to 1 cm in size

___ pT2#: Invades the muscularis propria or greater than 1 cm in size

___ pT3#: Invadesthrough the muscularis propria into subserosal tissue without penetration of
overlying serosa

___ pT4#: Invades visceral peritoneum (serosa) or other organs or adjacent structures
#
Note: For any T, add (m) for multiple tumors [TX(#) or TX(m), where X = 1–4 and # = number of primary tumors
identified##]; for multiple tumors with different Ts, use the highest.

##
Example: If there are 2 primary tumors, 1 of which penetrates only the subserosa, we define the primary tumor as either
T3(2) or T3(m).

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes 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

___ pM1a: Metastasis confined to liver

___ pM1b: Metastasis in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node,
peritoneum, bone)

Specify site(s), if known: __________________________

___ pM1c:Both hepatic and extrahepatic metastases

Specify site(s), if known: __________________________

 10. Carcinomas of the Thyroid Gland
Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note M)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

For Papillary, Follicular, Poorly Differentiated, Oncocytic (Hürthle cell) Cell, and Anaplastic Thyroid
Carcinoma

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor ≤2 in greatest dimension, limited to the thyroid

___ pT1a: Tumor ≤1 cm in greatest dimension limited to the thyroid

___ pT1b: Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid

___ pT2: Tumor >2 cm, but ≤4 cm in greatest dimension, limited to thyroid

___ pT3: Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only
strap muscles

___ pT3a: Tumor >4 cm limited to the thyroid

___ pT3b: Gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid,
thyrohyoid, or omohyoid muscles) from a tumor of any size

___ pT4: Includes gross extrathyroidal extension beyond the strap muscles

___ pT4a: Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea,
esophagus, or recurrent laryngeal nerve from a tumor of any size
___ pT4b: Gross extrathyroidal extension invading prevertebral fascia or encasing the carotid
artery ormediastinal vessels from a tumor of any size

Note: There is no category of carcinoma in situ (pTis) relative to carcinomas of thyroid gland.

For Medullary Thyroid Carcinoma

Primary Tumor(pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor ≤2 in greatest dimension, limited to the thyroid

___ pT1a: Tumor ≤1 cm in greatest dimension limited to the thyroid

___ pT1b: Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid

___ pT2: Tumor >2 cm, but ≤4 cm in greatest dimension, limited to thyroid

___ pT3: Tumor >4 cm or with extrathyroidal extension

___ pT3a: Tumor >4 cm in greatest dimension limited to the thyroid

___pT3b: Tumor of any size with gross extrathyroidal extension invading only strap muscles
(sternohyoid, sternothyroid, thyrohyoid or omohyoid muscles)

___pT4: Advanced disease

___pT4a: Moderately advanced disease; tumor of any size withgross extrathyroidal extension
into the nearby tissues ofthe neck, including subcutaneous soft tissue, larynx,trachea,
esophagus, or recurrent laryngeal nerve

___pT4b: Very advanced disease; tumor of any size withextension toward the spine or into nearby
large bloodvessels, gross extrathyroidal extension invading the prevertebral fascia, or
encasingthe carotid artery or mediastinal vessels

For All Carcinomas of the Thyroid

Regional Lymph Nodes(pN)#

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No evidence of locoregional lymph node metastasis #

___ pN0a: One or more cytologically or histologically confirmed benign lymph nodes

___ pN1: Metastasis to regional nodes

___ pN1a: Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal/Delphian, or

upper mediastinal) lymph nodes. This can be unilateral or bilateral disease.

___ pN1b: Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II,
III, IV, or V) or retropharyngeal lymph nodes
#
N0b is defined as no radiologic or clinical evidence of locoregional lymph node metastasis.

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

___ pM1: Distant metastasis

Specify site(s), if known: ____________________________

11. Carcinoma and Carcinosarcoma of the Endometrium

Pathologic Stage Classification(pTNM, AJCC 8thEdition) (Note J)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___pT1: Tumor confined to the corpus uteri, including endocervical glandular involvement

___ pT1a: Tumor limited to endometrium or invadingless than half of the myometrium

___ pT1b: Tumor invading one-half or more of the myometrium

___pT2: Tumor invadingthe stromal connective tissue of the cervix but not extending beyond
the uterus. This does NOT include endocervical glandular involvement

___pT3: Tumor involving serosa, adnexa, vagina, or parametrium

___ pT3a: Tumor involves serosa and/or adnexa (direct extension or metastasis)
___ pT3b: Vaginal involvement (direct extension or metastasis) or parametrial involvement

___ pT4: Tumor invading thebladder mucosa and/or bowel mucosa (bullous edema is not
sufficient to classify a tumor as T4)#
#
Note: Tumor has to involve the mucosal surface

Regional Lymph Nodes Modifier (required only if applicable)

___ (sn)#
#
Note: Suffix (sn) is required if applicable and added to the N category when only sentinel lymph node biopsy is performed.If
after a sentinel node biopsy, the patient then undergoes a complete lymph node dissection, the (sn) suffix is not used.

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis

___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm

___ pN1: Regional lymph node metastasis to pelvic lymph nodes

___pN1mi: Regional lymph node metastasis (greater than 0.2 mm but not greater than 2 mm in
diameter) to pelvic lymph nodes#

___pN1a Regional lymph node metastasis (greater than 2 mm in diameter) to pelvic lymph nodes

___ pN2: Regional lymph node metastasis to para-aortic lymph nodes, with or without positive
pelvic lymph nodes

___ pN2mi: Regional lymph node metastasis (greater than 0.2 mm but not greater than 2 mm in
diameter) to para-aortic lymph nodes, with or without positive pelvic lymph nodes #

___ pN2a: Regional lymph node metastasis (greater than 2 mm in diameter) to para-aortic lymph
nodes, with or without positive pelvic lymph nodes
#
Note:Even onemetastasis >2.0 mm would qualify the classification as pN1a and pN2a.

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

___ pM1: Distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease,
lung, liver, or bone. It excludes metastasis to pelvic or para-aortic lymph nodes, vagina,
uterineserosa, or adnexa)
Specify Site(s),if known: ______________________________

+ FIGO Stage (2018 FIGO Cancer Report)

+ ___ 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

12. Primary Tumors of the Ovary, Fallopian Tube, or Peritoneum

Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note K)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___pT1: Tumor limited to ovaries (oneor both)or fallopian tube(s)

___ pT1a: Tumor limited to one ovary (capsule intact) or fallopian tube, no tumor on ovarian or
fallopian tube surface; no malignant cells in ascites or peritoneal washings #

___ pT1b: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian
or fallopian tube surface; no malignant cells in ascites or peritoneal washings

___ pT1c: Tumor limited to oneor both ovariesor fallopian tubes with any of the following:

___ pT1c1: Surgical spill

___ pT1c2: Capsule ruptured before surgery or tumor on ovarianor fallopian tube surface

___ pT1c3: Malignant cells in ascites or peritoneal washings

___pT2: Tumor involves one or both ovaries or fallopian tubes with pelvic extension below
pelvic brim or primary peritoneal cancer
___ pT2a: Extension and/or implants on uterus and/or fallopian tube(s) and/or ovaries.

___ pT2b: Extension to and/or implants on other pelvic tissues.

___pT3: Tumor involves oneor both ovaries or fallopian tubes, or primary peritoneal
cancer,with microscopically confirmed peritoneal metastasis outside the pelvis and/or
metastasis to retroperitoneal (pelvic and/or para-aortic) lymph nodes

___ pT3a: Microscopic extra-pelvic (above the pelvicbrim) peritoneal involvement with or
without positive retroperitoneal lymph nodes

___ pT3b: Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension
with or without metastasis to retroperitoneal lymph nodes

___ pT3c: Macroscopic peritoneal metastasis beyond pelvis more than 2 cm in greatest
dimension with or without metastasis to the retroperitoneal lymph nodes (includes
extension of tumor to capsule of liver and spleen without parenchymal involvement of
either organ)

# Note: Serous tubal intraepithelial carcinoma(STIC) should be staged as pT1a if it involves one tube only, as pT1b if it
involves both tubes, and as pT1c3 if it is accompanied by positive peritoneal washing washings or ascites.Nonmalignant
ascites is not classified. The presence of ascites does not affect staging unless malignant cells are present.

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm

___pN1: Positive retroperitoneal lymph nodes only (histologically confirmed)

___ pN1a: Metastasis up to and including 10 mm in greatest dimension

___ pN1b: Metastasis more than 10 mm in greatest dimension

Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Distant metastasis, including pleural effusion with positive cytology; liver or splenic
parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal
lymph nodes and lymph nodes outside the abdominal cavity); and transmural
involvement of intestine

___ pM1a: Pleural effusion with positive cytology

___ pM1b: Liver or splenic parenchymal metastases; metastases to extra-abdominal organs

(including inguinal lymph nodes and lymph nodes outside the abdominal cavity);
transmural involvement of intestine

Specify site(s), if known: ____________________________

Note: Parenchymal liver or splenic metastasis is classified as stage IV disease, whereas liver or splenic capsule
metastasis is classified as stage III disease. Non-regional lymph node metastases (such as inguinal,
supraclavicular, and axillary nodes) are considered M1. Involvement of surface of diaphragm is considered pT3;
however, involvement of skeletal muscle of diaphragm or abdominal wall tissue beyond the peritoneum is
considered distant metastasis (M1).

+ FIGO Stage (2018 FIGO Cancer Report)

+ ___ I: Tumor confined to ovaries or fallopian tube(s)

+ ___ IA: Tumor limited to 1ovary (capsule intact) or fallopian tube; no tumor on ovarian or
fallopian tube surface; nomalignant cells in the ascites or peritonealwashings

+ ___ 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 1or 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 1or 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 tubesand/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 theperitoneum 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 peritonealmetastases beyond the pelvic brim ≤2 cmin greatest
dimension,with orwithoutmetastasis 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 extra-abdominal 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

13. Primary Gestational Trophoblastic Malignancy

Pathologic Stage Classification (pT, pM, AJCC 8th Edition) (Note B)

Note: Reporting of pT and (when applicable) pM categories is based on information available to the pathologist at the time
the report is issued. Only the applicable T or M category is required for reporting; their definitions need not be included in
the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ r (recurrent)

___ y (posttreatment)
Primary Tumor (pT)
___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor confined to uterus

___ pT2: Tumor extends to other genital structures (ovary, tube, vagina, broad ligaments) by
metastasis or direct extension

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

___ pM1: Distant metastasis

___ pM1a: Lung metastasis

___ pM1b: All other distant metastasis

Specify site(s), if known (select all that apply)

___ Lung

___ Spleen

___ Kidney

___ Gastrointestinal tract

___ Liver

___ Brain

___ Lymph node(s) (specify) #: ___________________________

___ Other (specify): ___________________________

#
Any lymph node metastasis should be classified as metastatic (M1b) disease.

+ Number of Metastasis

+ ___ 1-4

+ ___ 5-8

+ ___ >8
+ FIGO Stage (2015 FIGO Cancer Report)

+ ___ I: Disease confined to the uterus

+ ___ II: Gestational trophoblastic tumor extends outside of the uterus, but limited to the genital
structures (adenexa, vagina, broad ligament)

+ ___ III: Gestational trophoblastic tumor extends to the lungs, with or without known genital tract
involvement

+ ___ IV: All other metastatic sites

14. Primary Carcinoma of the Uterine Cervix

Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note G)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Cervical carcinoma confined to uterus (extension to corpus should be disregarded)

___ pT1a: Invasive carcinoma diagnosed by microscopy only. Stromal invasion with a maximum
depth of 5.0 mm, measured from the base of the epithelium, and a horizontal spread of
7.0 mm or less. Vascular space involvement, venous or lymphatic, does not affect
classification.

___ pT1a1: Measured stromal invasion of 3.0 mm or less in depth and 7.0 mm or lessin horizontal
spread

___ pT1a2: Measured stromal invasion of more than 3.0 mm and not more than 5.0 mm, with a
horizontal spread of 7.0 mm or less
___ pT1b: Clinically visible lesion confined to the cervix or microscopic lesion greater than
T1a/IA2. Includes all macroscopically visible lesions, even those with superficial
invasion.

___ pT1b1: Clinically visible lesion 4.0 cm or less in greatest dimension

___ pT1b2: Clinically visible lesion more than 4.0 cmin greatest dimension

___ pT2: Cervical carcinoma invading beyond the uterus but not to the pelvic wall or to lower
third of the vagina

___ pT2a: Tumor without parametrial invasion

___ pT2a1: Clinically visible lesion 4.0 cm or less in greatest dimension

___ pT2a2: Clinically visible lesion more than 4.0 cm in greatest dimension

___ pT2b: Tumor with parametrial invasion

___ pT3: Tumor extending to the pelvic sidewall # and/or involving the lower third of the vagina and/or causing hydronephrosis or
nonfunctioning kidney

___ pT3a: Tumor involving the lower third of the vagina but not extending to the pelvic wall

___ pT3b: Tumor extending to the pelvic wall and/or causing hydronephrosis or nonfunctioning kidney

___ pT4: Tumor invading the mucosa of the bladder or rectum and/or extending beyond the true pelvis (bullous edema is not
sufficient to classify a tumor as T4)##
#
The pelvic sidewall is defined as the muscle, fascia, neurovascular structures, and skeletal portions of the bony
pelvis. On rectal examination, there is no cancer-free space between the tumor and pelvic sidewall.
##
Note: Ttumor should involve the mucosal surface
Note: The LAST definition of superficial invasive squamous cell carcinoma (SISCCA) conforms to T1a1.

+Regional Lymph NodesModifier

+ ___ (sn)

+ ___ (sn)(i-)

+ ___ (sn)(i+)

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastasis

___ pN0(i+):Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm

___ pN1: Regional lymph node metastasis

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

___ pM1: Distant metastasis(including peritoneal spread or involvement of the
supraclavicular, mediastinal, or distant lymph nodes; lung; liver; or bone)
Specify Site(s), if known: _________________________
+ FIGO Stage (2018 FIGO Cancer Report)

+ ___ 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 evenwith superficial
invasion are stage IB cancers.) Invasion is limited tomeasured stromal invasionwith a
maximum depth of 5 mm#

+___ IA1: Measured invasion of stroma less than 3 mm in depth ##

+___ IA2: Measured invasion of stroma at least 3 mmbutless than 5 mmin depth

+___ IB: Invasive carcinoma with measured deepest invasion of5 mmor greaterand limited to the
cervix uteri

+___ IB1: Invasive carcinoma that is less than 2 cmin greatest dimension with a depth of invasion
of 5 mm or greater

+___ IB2: Invasive carcinoma with a greatest dimension of at least 2 cm butless than 4 cm

+___ IB3: Invasive carcinoma 4 cm or greater in greatest dimension

+ ___ 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 less than 4 cm

+___ IIA2: Clinically visible lesion4 cm or greater

+___ IIB: Obvious parametrial involvement but not onto the pelvic sidewall

+ ___ III: The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall
and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or
para- aortic lymph nodes

+___ IIIA: Involvement of the lower third of the vagina but no extension onto pelvic sidewall

+___ IIIB: Extension onto the pelvic sidewall, and/or causing hydronephrosis/nonfunctioning
kidney (unless known to be due to another cause)

+ ___IIIC: Involvement of pelvic and/or para- aortic lymph nodes, irrespective of tumor size and
extent

+___IIIC1: Pelvic lymph node metastasis only

+___IIIC2: Para- aortic lymph node metastasis

+ ___ IV: Carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the
mucosa of the bladder and/or rectum(bullous edema is not sufficient) or spread to
distant organs

+___ IVA: Spread to adjacent pelvic organs,ie, tumor invading the mucosa of the bladder and/or
rectum (biopsy proven) and/or extending beyond the true pelvis (bullous edema is not
sufficient)

+___ IVB: Spread to distant organs

#
Note:For FIGO IA cancers, the depth of invasion should not bemore than 5 mm taken from the base of the
epithelium, either surface or glandular, fromwhich it originates. Vascular space invasion should notalter the
staging.
##
The LAST definition of superficial invasive squamous cell carcinoma (SISCCA) conforms to FIGO IA1.

15. Primary Sarcoma of the Uterus

Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note B)

Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ r (recurrent)

___ y (post-treatment)

For All Sarcomas Excluding Adenosarcoma (including Leiomyosarcoma, Endometrial Stromal

Sarcoma, and Undifferentiated Endometrial Sarcoma/Uterine Sarcoma)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor is limited to the uterus

___ pT1a: Tumor 5 cm or less in greatest dimension

___ pT1b: Tumor more than 5 cm

___ pT2: Tumor extends beyond the uterus, within the pelvis
___ pT2a: Tumor involves adnexa

___ pT2b: Tumor involves other pelvic tissues

___ pT3: Tumor infiltrates abdominal tissues

___ pT3a: Tumor infiltrates abdominal tissues in one site

___ pT3b: Tumor infiltrates abdominal tissues in more than one site

___ pT4: Tumor invades bladder or rectum

For Adenosarcoma

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor limited to the uterus

___ pT1a: Tumor limited to the endometrium/endocervix

___ pT1b: Tumor invades to less than half of the myometrium

___ pT1c: Tumor invades one half or more of the myometrium

___ pT2: Tumor extends beyond the uterus, but within the pelvis

___ pT2a: Tumor involves adnexa

___ pT2b: Tumor involves other pelvic tissues

___ pT3: Tumor infiltrates abdominal tissues

___ pT3a: Tumor infiltrates abdominal tissues in one site

___ pT3b: Tumor infiltrates abdominal tissues in more than one site

___ pT4: Tumor invades bladder and/or rectum

For All Sarcomas

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis

___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm

___ pN1: Regional lymph node metastasis

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

___ pM1: Distant metastasis (excluding adnexa, pelvic and abdominal tissues)

Specify site(s), if known: ______________________________

+ For All Sarcomas Excluding Adenosarcoma (Including Leiomyosarcoma, Endometrial Stromal

Sarcoma, and Undifferentiated Endometrial Sarcoma/Uterine Sarcoma)

+ FIGO Stage (2015 FIGO Cancer Report)

+ ___ I: Tumor limited to uterus

+ ___ IA: Less than or equal to 5 cm

+ ___ IB: More than 5 cm

+ ___ II: Tumor extends beyond the uterus, within the pelvis

+ ___ IIA: Adnexal involvement

+ ___ IIB: Involvement of other pelvic tissues

+ ___ III: Tumor invades abdominal tissues (not just protruding into the abdomen)

+ ___ IIIA: 1 site

+ ___ IIIB: More than 1 site

+ ___ IIIC: Metastasis to pelvic and/or para-aortic lymph nodes

+ ___ IV: Tumor invades bladder and/or rectum and/or distant metastasis

+ ___ IVA: Tumor invades bladder and/or rectal mucosa

+ ___ IVB: Distant metastasis

+ For Adenosarcoma
+ FIGO Stage (2015 FIGO Cancer Report)

+ ___ I: Tumor limited to uterus

+ ___ IA: Tumor limited to endometrium/endocervix with no myometrial invasion

+ ___ IB: Less than or equal to half myometrial invasion

+ ___ IC: More than half myometrial invasion

+ ___ II: Tumor extends beyond the uterus, within the pelvis

+ ___ IIA: Adnexal involvement

+ ___ IIB: Tumor extends to extrauterine pelvic tissue

+ ___ III: Tumor invades abdominal tissues (not just protruding into the abdomen).

+ ___ IIIA: 1 site

+ ___ IIIB: More than 1 site

+ ___ IIIC: Metastasis to pelvic and/or para-aortic lymph nodes

+ ___ IV: Tumor invades bladder and/or rectum and/or distant metastasis

+ ___ IVA: Tumor invades bladder and/or rectal mucosa

+ ___ IVB: Distant metastasis

16. Primary Carcinoma of the Vagina

Pathologic Stage Classification (pTNM, AJCC 8th Edition) (NoteD)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)
___ r (recurrent)
___ y (posttreatment)
Primary Tumor (pT)
___ pTX: Primary tumor cannot be assessed
___ pT0: No evidence of primary tumor
___ pT1: Tumor confined to the vagina
___ pT1a: Tumor confined to the vagina, measuring ≤2.0 cm
___ pT1b: Tumor confined to the vagina, measuring >2.0 cm
___ pT2: Tumor invading paravaginal tissues but not to pelvic sidewall
___ pT2a: Tumor invading paravaginal tissues but not to pelvic wall,
measuring ≤2.0 cm
___ pT2b: Tumor invading paravaginal tissues but not to pelvic wall,
measuring >2.0 cm
___ pT3: Tumor extending to the pelvic sidewall#and/or causing
hydronephrosis or nonfunctioning kidney
___ pT4: Tumor invadingthe mucosa of the bladder or rectum## and/or
extending beyond the true pelvis(bullous edema is not sufficient
evidence to classify a tumor as T4)
#
Pelvic sidewall is defined as the muscle, fascia, neurovascular structures, or
skeletal portions of thebony pelvis. On rectal examination, there should be no
cancer-free space between the tumor and pelvic sidewall.Tumor causing
hydronephrosis or nonfunctioning kidney is an indirect indication of pelvic
sidewall involvement.
## Mucosal surface of bladder or rectum should be involved

Regional Lymph Nodes (pN)

___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than
0.2 mm
___ pN1: Pelvic or inguinal lymph node metastasis

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

case)
___ pM1: Distant metastasis
Specify Site(s), if known: ___________________________

+ FIGO Stage(2018FIGO Cancer Report)

+ ___ I: Carcinoma is limited to the vaginal wall.It has not spread to
nearby lymph nodes (N0) or to distant sites (M0)
+ ___ II: Carcinoma has involved the para-vaginal tissue but has
notextended to the pelvic wall. It has not spread to nearby lymph
nodes (N0) or to distant sites (M0)
+ ___ III: Carcinoma has extended to the pelvic walland/or involving the
lower third of the vagina and/orcausing hydronephrosis or
nonfunctioning kidney or T1-T3 tumor that has also spread to
nearby lymph nodes in the pelvis or groin (inguinal) area (N1) but
not distant sites
+ ___ IV: Carcinoma has extended beyond the true pelvis or hasinvolved
the mucosa of the bladder or rectum(bullous edemaas such does not
permit a case to be allotted to stage IV)
+ ___ IVA: Tumor invades bladder and/or rectal mucosa and/or
directextension beyond the true pelvis. It might or might not have
spread to lymph nodes in the pelvis or groin (inguinal area) (Any
N). It has not spread to distant sites (M0)
+ ___ IVB: Spread to distant organs (M1). It can be any size and might or
might not have grown into nearby structures or organs (Any T) It
might or might not have spread to nearby lymph nodes (Any N)
17. Primary Carcinoma of the Vulva
Pathologic Stage Classification (pTNM, AJCC 8th Edition) (Note H)
Note: Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the
time the report is issued. Only the applicable T, N, or M category is required for reporting; their definitions need not be
included in the report. The categories (with modifiers when applicable) can be listed on 1 line or more than 1 line.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Tumor confined to the vulva and / or perineum #

___ pT1a: Lesions 2 cm or less, confined to the vulva and/or perineum, and with stromal invasion
of 1.0 mm or less ##

___ pT1b: Lesions more than 2 cm, or any size with stromal invasion more than 1.0 mm, confined
to the vulva and/or perineum
___ pT2: Tumor of any size with extension to adjacent perineal structures (lower/distal third of
the urethra, lower/distal third of the vagina, anal involvement)

___ pT3: Tumor of any size with extension to any of the following: upper/proximal two-thirds of
the urethra, upper/proximal two-thirds of the vagina, bladder mucosa, or rectal
mucosa,### or fixed to pelvic bone
#
Multifocal lesions should be designated as such. The largest lesion or the lesion with the greatest depth of
invasion will be the target lesion identified to address the highest pT stage. Depth of invasion is defined as the
measurement of the tumor from the epithelial–stromal junction of the adjacent most superficial dermal papilla to
the deepest point of invasion.
##
Note: The LAST definition of superficial invasive squamous cell carcinoma (SISCCA) conforms to AJCC pT1a/FIGO IA

###
Mucosal surface of bladder or rectum should be involved

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

+ Modifier
+ ___ (sn)

+ ___ (sn)(i-)

+ ___ (sn)(i+)
Regional Lymph Nodes Category (pN)
___ pNX: Regional lymph nodes cannot be assessed

___ pN0: No regional lymph node metastasis

___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm

___ pN1: Regional lymph node metastasis with one or two lymph node metastases each less than
5 mm, or one lymph node metastasis ≥ 5 mm

___ pN1a: One or two lymph node metastasis each less than 5 mm #

___ pN1b: One lymph node metastasis ≥ 5 mm

___ pN2: Regional lymph node metastasis with three or more lymph node metastases each less
than 5 mm, or two or more lymph node metastases ≥ 5 mm, or lymph node(s) with
extranodal extension

___ pN2a: Three or more lymph node metastases each less than 5 mm #

___ pN2b: Two or more lymph node metastases ≥ 5 mm

___ pN2c: Lymph node(s) with extranodal extension

___ pN3: Fixed or ulcerated regional lymph node metastasis

#
Includes micrometastasis, N1mi and N2mi.The site, size, and laterality of lymph node metastases should be recorded.

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

___ pM1: Distant metastasis (including pelvic lymph node metastasis) #

Specify site(s), if known: ____________________________

#
Internal iliac/hypogastric, external iliac, and common iliac lymph nodes are considered distant metastasis.

+ FIGO Stage (2018 FIGO Cancer Report)

+___ I: Tumor confined to the vulva

+___ IA: Lesions ≤2 cm in size, confined to the vulva or perineum and with stromal invasion ≤1.0
mm, no nodal metastasis#

+___ IB: Lesions >2 cm in size or with stromal invasion >1.0 mm, confined to the vulva and/or
perineum, with negative nodes
+___ II: Tumor of any size with extension to adjacent perineal structures (lower third of urethra,
lower third of vagina, anus) with negative nodes

+ ___ III: Tumor of any size with or without extension to adjacent perineal structures (lower third
of urethra, lower third of vagina, anus) with positive inguinofemoral nodes

+___ IIIA: With 1 lymph node metastasis (≥5 mm)

+___ IIIA: With 1 to 2 lymph node metastasis(es) (<5 mm)

+___ IIIB: With 2 or more lymph node metastases (≥5 mm)

+___ IIIB: With 3 or more lymph node metastases (<5 mm)

+___ IIIC: With positive nodes with extracapsular spread

+ ___ IV: Tumor invades other regional (upper two-thirds urethra, upper two-thirds vagina), or
distant structures

+___ IVA: Tumor invades any of the following: upper urethral and/or vaginal mucosa, bladder
mucosa, rectal mucosa, or fixed to pelvic bone, or fixed or ulcerated inguino-femoral
lymph nodes

+___ IVB: Any distant metastasis including pelvic lymph nodes

#
Note: The LAST definition of superficial invasive squamous cell carcinoma (SISCCA) conforms to AJCC pT1a/FIGO IA.