Appendix AJCC 6th Edition; CAP 2006  
  New 2006-08-11 Cancer Case Summary
Applies to: Invasive carcinomas of the appendix. Excludes: Carcinoid, Lymphoma and sarcoma
Diagnosis Example: Appendix - Mucinous Adenocarcinoma See Cancer Case Summary
# Report Header Dictation Options Note
Surgical Pathology Cancer Case Summary  
1 Specimen Type Appendectomy State all tissues received
    Appendectomy with right hemicolectomy  
2 Specimen Size Appendix__ x ___ x ___ cm  
    Right Colon __ x ___ x ___ cm  
4 Tumour Site Proximal half fo appendix  
    Distal half of appendix  
    Diffusely involving appendix  
    Appendix, not otherwise specified  
5 Tumour Size __ x ___ x ___ cm  
    Cannot be determined (See Comment)  
6 Tumour Configuration Ulcerative  
    Other (specify)  
7 Perforation Absent  
    Present over tumour  
    Present over non-tumourous area  
8 Histologic Type Adenocarcinoma  
    Mucinous (colloid) adenocarcinoma (greater than 50% mucinous) Note re Mucocele, Villous Adenoma etc
    Signet-ring cell carcinoma (greater than 50% signet-ring cells) In contrast to pure goblet cell carcinoids, mixed carcinoid-adenocarcinomas and signet-ring cell carcinomas behave aggressively
    Small cell carcinoma  
    Undifferentiated carcinoma  
    Other (specify): ____________________________  
    Carcinoma, type cannot be determined (see Comment)  
9 Histologic Grade Not applicable  
    GX: Cannot be assessed  
    Grade 1 (well differentiated) 95% gland formation
    Grade 2 (moderately differentiated) 50% to 95% gland formation
    Grade 3 (poorly differentiated) 5% to 50% gland formation
    Grade 4 (undifferentiated) <5% gland formation
10 Extent of Tumour Cannot be assessed  
    No evidence of primary tumor  
    Intraepithelial carcinoma (no invasion)  
    Intramucosal carcinoma (invasion of lamina propria)  
    Tumor invades submucosa  
    Tumor invades muscularis propria  
    Tumor invades through the muscularis propria into the subserosa or mesoappendix  
    Tumor directly invades other organs or structures, and/or perforates visceral peritoneum  
11 Proximal Margin Cannot be assessed  
    Uninvolved by invasive carcinoma  
    Involved by invasive carcinoma  
    Adenoma absent at proximal margin (for appendectomy specimens)  
    Adenoma present at proximal margin (for appendectomy specimens)  
    Specify grade of dysplasia: _____________________  
12 Distal Margin Not applicable (appendectomy specimen)  
    Cannot be assessed  
    Uninvolved by invasive carcinoma  
    Involved by invasive carcinoma  
13 Mesenteric Margin Cannot be assessed  
    Uninvolved by invasive carcinoma  
    Involved by invasive carcinoma  
14 Distance of inv. ca from closest mesenteric margin __ cm  
15 Circumferential (Radial) Margin Not applicable  
    Cannot be assessed  
    Uninvolved by invasive carcinoma  
    Involved by invasive carcinoma (tumor present 0-1 mm from CRM)  
16 Venous (Large Vessel) Invasion Absent / Indeterminate V0
    Present: Intramural or Extramural V1
    Gross Venous inv. V2
17 Lymphatic (Small Vessel) Invasion Absent / Indeterminate L0
    Present: Intramural or Extramural L1
18 Perineural Invasion Absent  
19 Lymph Nodes # Positive / __ Total #  
    Largest involved LN __ cm  
20 Other Findings NA or specify Tumour necrosis, etc
21 Other Tissues / Organs NA or specify  
22 Correlation With Biopsy Or Cytology NA, Agrees, Disagrees Explain discrepancy if any
23 Correlation with Operative Consult (FS) NA, Agrees, Disagrees Explain discrepancy if any
24 Internal Consultation Pathologist name / NA  
26 pTNM  AJCC 6th Ed   See note re r, y, (m)
  Tumour TX Primary tumor cannot be assessed  
    T0 No evidence of primary tumor  
    Tis Intraepithelial carcinoma (no invasion)  
    Tis Intramucosal ca (invasion of lamina propria)  
    T1 Tumor invades submucosa  
    T2 Tumor invades muscularis propria  
    T3 Tumor invades through muscularis propria into subserosa or into mesoappendix  
    T4 Tumor directly invades other organs/structures, and / or perforates visceral peritoneum  
  Lymph Nodes NX Regional lymph nodes cannot be assessed The regional lymph nodes for the appendix include the anterior cecal, posterior cecal, ileocolic, and right colic lymph nodes.
    N0 No regional lymph node metastasis  
    N1 Regional lymph node metastasis  
  Metastases Mx Distant Mets Cannot Be Assessed Seeding of peritoneum or abdominal organs is considered distant metastasis
    M0 No Distant Met  
    M1 Distant Mets  
  Residual Tumour RX Residual tumour cannot be assessed  
    R0 No residual tumour  
    R1 Microscopic residual tumour  
    R2 Gross residual tumour  
  Venous/Lymphatic Inv. V,L See Note re Venous Lymphative Inv.