Exocrine Pancreas Cancer Protocol



Exocrine Pancreas Cancer Protocol


Laura Webb Lamps, MD










Pancreas (Exocrine): Resection





































































































































































































































































































































































































































































Surgical Pathology Cancer Case Summary (Checklist)


Specimen (select all that apply)



____ Head of pancreas



____ Body of pancreas



____ Tail of pancreas



____ Duodenum



____ Stomach



____ Common bile duct



____ Gallbladder



____ Spleen



____ Adjacent large vessels




____ Portal vein




____ Superior mesenteric vein




____ Other large vessel (specify): ______________________________



____ Other (specify): ______________________________



____ Not specified



____ Cannot be determined


Procedure



____ Pancreaticoduodenectomy (Whipple resection), partial pancreatectomy



____ Pancreatoduodenectomy (Whipple resection), total pancreatectomy



____ Partial pancreatectomy, pancreatic body



____ Partial pancreatectomy, pancreatic tail



____ Other (specify): ______________________________



____ Not specified


Tumor Site (select all that apply)



____ Pancreatic head



____ Uncinate process



____ Pancreatic body



____ Other (specify): ______________________________



____ Not specified


Tumor Size



Greatest dimension: __________ cm



*Additional dimensions: _________ × __________ cm



____ Cannot be determined


Histologic Type (select all that apply)



____ Ductal adenocarcinoma



____ Mucinous noncystic carcinoma



____ Signet ring cell carcinoma



____ Adenosquamous carcinoma



____ Undifferentiated (anaplastic) carcinoma



____ Undifferentiated carcinoma with osteoclast-like giant cells



____ Mixed ductal-endocrine carcinoma



____ Serous cystadenocarcinoma




____ Noninvasive




____ Invasive



____ Intraductal papillary-mucinous carcinoma




____ Noninvasive




____ Invasive



____ Acinar cell carcinoma



____ Acinar cell cystadenocarcinoma



____ Mixed acinar-endocrine carcinoma



____ Other (specify):______________________________


Histologic Grade (ductal carcinoma only)



____ Not applicable



____ GX: Cannot be assessed



____ G1: Well differentiated



____ G2: Moderately differentiated



____ G3: Poorly differentiated



____ G4: Undifferentiated



____ Other (specify):______________________________


Microscopic Tumor Extension (select all that apply)



____ Cannot be assessed



____ No evidence of primary tumor



____ Carcinoma in situ



____ Tumor is confined to pancreas



____ Tumor invades ampulla of Vater or sphincter of Oddi



____ Tumor invades duodenal wall



____ Tumor invades peripancreatic soft tissues




*____ Tumor invades retroperitoneal soft tissue




*____ Tumor invades mesenteric adipose tissue




*____ Tumor invades mesocolon




*____ Tumor invades other peripancreatic soft tissue (specify):______________________________




____ Tumor invades extrapancreatic common bile duct



____ Tumor invades other adjacent organs or structures (specify):______________________________


Margins (select all that apply)



____ Cannot be assessed



____ Margins uninvolved by invasive carcinoma




Distance of invasive carcinoma from closest margin:____________ mm




*Specify margin (if possible):______________________________



____ Margins uninvolved by carcinoma in situ



____ Margin(s) involved by carcinoma in situ




____ Carcinoma in situ present at common bile duct margin




____ Carcinoma in situ present at pancreatic parenchymal margin



____ Margin(s) involved by invasive carcinoma




____ Uncinate process (retroperitoneal) margin (nonperitonealized surface of uncinate process)




____ Distal pancreatic margin




____ Common bile duct margin




____ Proximal pancreatic margin




____ Other (specify):______________________________



*____ Invasive carcinoma involves posterior retroperitoneal surface of pancreas


Treatment Effect (applicable to carcinomas treated with neoadjuvant therapy) (select all that apply)



____ No prior treatment



____ Present




*____ No residual tumor (complete response, grade 0)




*____ Marked response (grade 1, minimal residual cancer)




*____ Moderate response (grade 2)



____ No definite response identified (grade 3, poor or no response)



____ Not known


Lymph-Vascular Invasion



____ Not identified



____ Present



____ Indeterminate


Pathologic Staging (pTNM)



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




____ m (multiple primary tumors)




____ r (recurrent)




____ y (post-treatment)



Primary tumor (pT)




____ pTX: Cannot be assessed




____ pT0: No evidence of primary tumor




____ pTis: Carcinoma in situ




____ pT1: Tumor limited to pancreas, ≤ 2 cm in greatest dimension




____ pT2: Tumor limited to pancreas, > 2 cm in greatest dimension




____ pT3: Tumor extends beyond pancreas but without involvement of celiac axis or superior mesenteric artery




____ pT3: Tumor involves celiac axis or superior mesenteric artery



Regional lymph nodes (pN)




____ pNX: Cannot be assessed




____ pN0: No regional lymph node metastasis




____ pN1: Regional lymph node metastasis





Specify: Number examined:__________






Number involved:___________



Distant metastasis (pM)




____ Not applicable




____ pM1: Distant metastasis





*Specify site(s), if known:______________________________


*Additional Pathologic Findings (select all that apply)



* ____ None identified



*____ Pancreatic intraepithelial neoplasia (highest grade: PanIN ____________)



*____ Chronic pancreatitis



*____ Acute pancreatitis



*____ Other (specify):______________________________


* Ancillary Studies



*Specify:______________________________


*Clinical History (select all that apply)



*____ Neoadjuvant therapy



*____ Familial pancreatitis



*____ Familial pancreatic cancer syndrome



*____ Other (specify):______________________________



*____ Not specified


* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Carcinoma of the Exocrine Pancreas.” Web posting date October 2009, www.cap.org. Protocol applies to all epithelial tumors of the exocrine pancreas. Endocrine tumors and tumors of the ampulla of Vater are not included.

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Exocrine Pancreas Cancer Protocol
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