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Tumor Tip of the Week – Another Nugget from Chapter 1 Imaging Studies Used in Assigning Pathological Stage

Scenario:
03-01-2021 Total Vaginal Hysterectomy Path shows FIGO Grade 1 Endometrioid Adenocarcinoma Stage 1A [only scans prior to surgery were a transvaginal US which showed very small uterine fibroid but no other abnormalities]

03-05-2021 After surgery physician discusses final pathology, will plan for surveillance x 5 years, will order CT Abdomen/Pelvis would follow up if any nodal disease identified.

03-12-2021 CT Ab/Pelvis Indication: uterine/cervical cancer, staging. Impression: Post-surgical changes. Sub centimeter right internal iliac node is nonspecific and can be followed on subsequent exams for stability.

3-26-2021 Physician sees patient for fu, physician stages as pT1a cN0 cM0 Stage 1A.

Question: Can you use the information from the CT to assign the pathologic N as cN0?

  • Yes
  • No

Answer & Rationale:
YES

AJCC 8th Edition Chapter 1 page 18 under Criteria for assigning pathological stage   Imaging studies used in assigning pathological stage:   Imaging studies performed after surgery are included in the pathological staging if they are within the time frame or staging window.

AJCC Critical Clarifications for Registrars Node Status Not Required in Rare Circumstances document [TIP: PRINT this and put in your AJCC Manual] https://www.facs.org/quality-programs/cancer/ajcc/staging-education/registrar

CAnswer Forum Post http://cancerbulletin.facs.org/forums/forum/ajcc-tnm-staging-8th-edition/female-reproductive-organs-chapters-49-56/corpus-uteri-carcinoma-and-carcinosarcoma-chapter-53/113723-timing-and-cn0-for-path-stage-endometrial-cancer

http://cancerbulletin.facs.org/forums/forum/ajcc-tnm-staging-8th-edition/female-reproductive-organs-chapters-49-56/corpus-uteri-carcinoma-and-carcinosarcoma-chapter-53/95483-endometrial-staging-with-limited-information

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