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 IVA
pM1a due to the +biopsy of the metastatic site
Grade Clinical: G2 Moderately differentiated Per biopsy of primary site |
Pathologic Stage: cT3 cN1 pM1a IVA
When 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 differentiated Path 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 IVA
cM1a no biopsy of distant site
Grade Clinical: G2 Moderately differentiated Per biopsy of primary site |
Pathologic Stage: TNM BLANK Stage 99
Case 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 IVA
pM1a due to the +biopsy of the metastatic site
Grade Clinical: 9 No biopsy of the primary site, cannot use the grade from the metastatic site |
Pathologic Stage: cT3 cN1 pM1a IVA
When 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: 9 No biopsy of the primary site, cannot use the grade from the metastatic site
|