10-04-2024 cM1 pM1 without primary site surgery
Scenario 1: Path Proven Mets in Clinical Timeframe + Biopsy of Primary Site
- Colonoscopy biopsy rectum+ moderately differentiated adenocarcinoma.
- Needle biopsy of liver + metastatic adenocarcinoma, CT/EUS show clinical T3, clinical N1 case.
- No resection is done
| Clinical Stage/ Clinical Grade | Pathologic Stage / Path Grade |
| Clinical Stage: cT3 cN1 pM1a IVApM1a due to the +biopsy of the metastatic site Grade Clinical: G2 Moderately differentiatedPer biopsy of primary site | Pathologic Stage: cT3 cN1 pM1a IVAWhen you have path proven mets in clinical timeframe, the patient is eligible for path staging. Assign the path T & N Categories as cT3 cN1 and path M as pM1a* Refer to AJCC manual Chapter 1 (page 17& 22 of 3rd edition, page 36 Kindle version). Grade Pathological: G2: Moderately differentiatedPath Grade can be assigned because the case meets the criteria for path stage due to the path proven mets and you also have a biopsy of the primary site.*Refer to Grade Coding Instructions and Tables Instructions for Grade Pathological |
Scenario 2: Clinical Mets, not proven histologically in Clinical Timeframe + Biopsy of Primary Site
- Colonoscopy biopsy rectum+ moderately differentiated adenocarcinoma.
- CT/EUS show clinical T3, clinical N1, +Liver mets
- No resection is done
| Clinical Stage/ Clinical Grade | Pathologic Stage / Path Grade |
| Clinical Stage: cT3 cN1 cM1a IVAcM1a no biopsy of distant site Grade Clinical: G2 Moderately differentiatedPer biopsy of primary site | Pathologic Stage: TNM BLANK Stage 99Case not eligible for pathologic stage, no resection of primary site and no histologically proven mets. Grade Pathological: 9 Patient not eligible for path stage, to path grade will be a 9.*Refer to Grade Coding Instructions and Tables Instructions for Grade Pathological |
Scenario 3: Path Proven Mets in Clinical Timeframe -No Biopsy of Primary Site
- Biopsy of the Liver- Poorly differentiated adenocarcinoma c/w mets from Colon
- CT/EUS show clinical T3, clinical N1 case, + liver mets
- No resection is done, No biopsy of primary site
| Clinical Stage/ Clinical Grade | Pathologic Stage / Path Grade |
| Clinical Stage: cT3 cN1 pM1a IVApM1a due to the +biopsy of the metastatic site Grade Clinical: 9No biopsy of the primary site, cannot use the grade from the metastatic site | Pathologic Stage: cT3 cN1 pM1a IVAWhen you have path proven mets in clinical timeframe, the patient is eligible for path staging. Assign the path T & N Categories as cT3 cN1 and path M as pM1a* Refer to AJCC manual Chapter 1 (page 17& 22 of 3rd edition, page 36 Kindle version). Grade Pathological: 9No biopsy of the primary site, cannot use the grade from the metastatic site |
