Pharynx (Nasopharynx, Oropharynx, Hypopharynx)

Excisional Biopsy, Resection

Specimen (select all that apply)

_ _ _Nasopharynx

_ _ _Oropharynx

_ _ _Hypopharynx

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

Received

_ _ _Fresh

_ _ _In formalin

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Procedure (select all that apply)

_ _ _Incisional biopsy

_ _ _Excisional biopsy

_ _ _Resection

_ _ _Tonsillectomy

_ _ _Laryngopharyngectomy

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Neck (lymph node) dissection (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

^* Specimen Integrity

^* _ _ _Intact

^* _ _ _Fragmented

Specimen Size

Greatest dimensions: _ _ _ _ _ _ _ _ _ x _ _ _ _ _ _ _ _ _ x _ _ _ _ _ _ _ _ _ cm

^* Additional dimensions (if more than 1 part): _ _ _ _ _ _ _ _ _ x _ _ _ _ _ _ _ _ _ x _ _ _ _ _ _ _ _ _ cm

Specimen Laterality

_ _ _Left

_ _ _Right

_ _ _Bilateral

_ _ _Midline

_ _ _Not specified

Tumor Site (select all that apply)

_ _ _Nasopharynx

_ _ _Nasopharyngeal tonsils (adenoids)

_ _ _Oropharynx

_ _ _Palatine tonsil

_ _ _Base of tongue, including lingual tonsil

_ _ _Soft palate

_ _ _Uvula

_ _ _Pharyngeal wall (posterior)

_ _ _Hypopharynx

_ _ _Piriform sinus

_ _ _Postcricoid

_ _ _Pharyngeal wall (posterior &/or lateral)

_ _ _Other

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

_ _ _Tumor Laterality

_ _ _Left

_ _ _Right

_ _ _Bilateral

_ _ _Midline

_ _ _Not specified

_ _ _Tumor Focality

_ _ _Single focus

_ _ _Bilateral

_ _ _Multifocal (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Tumor Size

Greatest dimension: _ _ _ _ _ _ _ _ _ cm

^* Additional dimensions: _ _ _ _ _ _ _ _ _ x _ _ _ _ _ _ _ _ _ cm

_ _ _Cannot be determined

_ _ _^* Tumor Description (select all that apply)

^* Gross subtype

^* _ _ _Polypoid

^* _ _ _Exophytic

^* _ _ _Endophytic

^* _ _ _Ulcerated

^* _ _ _Sessile

^* _ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Macroscopic Extent of Tumor

^* Specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Histologic Type (select all that apply)

_ _ _Carcinomas of nasopharynx

_ _ _Keratinizing squamous cell carcinoma

_ _ _Nonkeratinizing carcinoma

_ _ _Differentiated carcinoma

_ _ _Undifferentiated carcinoma

_ _ _Basaloid squamous cell carcinoma

_ _ _Carcinomas of oropharynx and hypopharynx

_ _ _Squamous cell carcinoma, conventional

_ _ _Variants of squamous cell carcinoma

_ _ _Acantholytic squamous cell carcinoma

_ _ _Adenosquamous carcinoma

_ _ _Basaloid squamous cell carcinoma

_ _ _Papillary squamous cell carcinoma

_ _ _Spindle cell squamous carcinoma

_ _ _Verrucous carcinoma

_ _ _Lymphoepithelial carcinoma (non-nasopharyngeal)

_ _ _Adenocarcinomas (non-salivary gland type)

_ _ _Nasopharyngeal papillary adenocarcinoma

_ _ _Adenocarcinoma, not otherwise specified (NOS)

_ _ _Low grade

_ _ _Intermediate grade

_ _ _High grade

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Carcinomas of minor salivary glands

_ _ _Acinic cell carcinoma

_ _ _Adenoid cystic carcinoma

_ _ _Adenocarcinoma, not otherwise specified (NOS)

_ _ _Low grade

_ _ _Intermediate grade

_ _ _High grade

_ _ _Basal cell adenocarcinoma

_ _ _Carcinoma ex-pleomorphic adenoma (malignant mixed tumor)

_ _ _Carcinoma, type cannot be determined

_ _ _Clear cell adenocarcinoma

_ _ _Cystadenocarcinoma

_ _ _Epithelial-myoepithelial carcinoma

_ _ _Mucoepidermoid carcinoma

_ _ _Low grade

_ _ _Intermediate grade

_ _ _High grade

_ _ _Mucinous adenocarcinoma (colloid carcinoma)

_ _ _Myoepithelial carcinoma (malignant myoepithelioma)

_ _ _Oncocytic carcinoma

_ _ _Polymorphous low-grade adenocarcinoma

_ _ _Salivary duct carcinoma

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Neuroendocrine carcinoma

_ _ _Typical carcinoid tumor (well-differentiated neuroendocrine carcinoma)

_ _ _Atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma)

_ _ _Small cell carcinoma (poorly differentiated neuroendocrine carcinoma)

_ _ _Combined (or composite) small cell carcinoma, neuroendocrine type

_ _ _Mucosal malignant melanoma

_ _ _Other carcinoma (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Carcinoma, type cannot be determined

Histologic Grade

_ _ _Not applicable

_ _ _GX: Cannot be assessed

_ _ _G1: Well differentiated

_ _ _G2: Moderately differentiated

_ _ _G3: Poorly differentiated

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Microscopic Tumor Extension

^* _ _ _Specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Margins (select all that apply)

_ _ _Cannot be assessed

_ _ _Margins uninvolved by invasive carcinoma

Distance from closest margin: _ _ _ _ _ _ _ _ _ mm or _ _ _ _ _ _ _ _ _ cm

Specify margin(s), per orientation, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Margins involved by invasive carcinoma

Specify margin(s), per orientation, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Margins uninvolved by carcinoma in situ (includes moderate and severe dysplasia)

Distance from closest margin: _ _ _ _ _ _ _ _ _ mm or _ _ _ _ _ _ _ _ _ cm

Specify margin(s), per orientation, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Margins involved by carcinoma in situ (includes moderate and severe dysplasia)

Specify margin(s), per orientation, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not applicable

Applicable only to squamous cell carcinoma and histologic variants

^* Treatment Effect (applicable to carcinomas treated with neoadjuvant therapy)

^* _ _ _Not identified

^* _ _ _Present (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _Indeterminate

Lymph-Vascular Invasion

_ _ _Not identified

_ _ _Present

_ _ _Indeterminate

_ _ _Perineural Invasion

_ _ _Not identified

_ _ _Present

_ _ _Indeterminate

_ _ _Lymph Nodes, Extranodal Extension

_ _ _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

_ _ _For all carcinomas (excluding mucosal malignant melanoma)

_ _ _Primary tumor (pT): Nasopharynx†

_ _ _pT1: Tumor confined to nasopharynx, or tumor extends to oropharynx &/or nasal cavity without parapharyngeal extension

_ _ _pT2: Tumor with parapharyngeal extension

_ _ _pT3: Tumor invades bony structures of skull base &/or paranasal sinuses

_ _ _pT4: Tumor with intracranial extension &/or involvement of cranial nerves, hypopharynx, orbit or with extension to infratemporal fossa/masticator space

_ _ _Parapharyngeal extension denotes posterolateral infiltration of tumor

_ _ _Primary tumor (pT): Oropharynx†

_ _ _pT1: Tumor ≤ 2 cm in greatest dimension

_ _ _pT2: Tumor > 2 cm but ≤ 4 cm in greatest dimension

_ _ _pT3: Tumor > 4 cm in greatest dimension or extension to lingual surface of epiglottis

_ _ _pT4a: Moderately advanced local disease

Tumor invades larynx, deep/extrinsic muscle of tongue, medial pterygoid muscles, hard palate, or mandible

_ _ _pT4b: Very advanced local disease

Tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base, or encases carotid artery

Note: Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of larynx

Primary tumor (pT): Hypopharynx†

_ _ _pT1: Tumor limited to 1 subsite of hypopharynx &/or ≤ 2 cm in greatest dimension

_ _ _pT2: Tumor invades > 1 subsite of hypopharynx or an adjacent site or measures > 2 but ≤ 4 cm in greatest dimension without fixation of hemilarynx

_ _ _pT3: Tumor measures > 4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus

_ _ _pT4a: Moderately advanced local disease

Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft tissue

_ _ _pT4b: Very advanced local disease

Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures

_ _ _Note: Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat

_ _ _Regional lymph nodes (pN)

_ _ _pNX: Cannot be assessed

_ _ _pN0: No regional lymph node metastasis

_ _ _Regional lymph nodes (pN): Nasopharynx†

_ _ _pN1: Unilateral metastasis in lymph node(s), ≤ 6 cm in greatest dimension, above supraclavicular fossa

_ _ _pN2: Bilateral metastasis in lymph node(s), ≤ 6 cm in greatest dimension, above supraclavicular fossa

_ _ _pN3: Metastasis in a lymph node > 6 cm &/or to supraclavicular fossa

_ _ _pN3a: > 6 cm in dimension

_ _ _pN3b: Extension to supraclavicular fossa

Specify: Number examined: _ _ _ _ _ _ _ _ _

Number involved: _ _ _ _ _ _ _ _ _

^* Size (greatest dimension) of largest positive lymph node: _ _ _ _ _ _ _ _ _

Metastases at level VII are considered regional lymph node metastases. Midline nodes are considered ipsilateral nodes

Supraclavicular zone or fossa is relevant to staging of nasopharyngeal carcinoma and is the triangular region defined by 3 points

1: Superior margin of sternal end of clavicle

2: Superior margin of lateral end of clavicle

3: Point where neck meets shoulder. Note that this would include caudal portions of levels IV and VB. All cases with lymph nodes (whole or in part) in fossa are considered N3b

Regional lymph nodes (pN): Oropharynx and hypopharynx†

_ _ _pN1: Metastasis in single ipsilateral lymph node, ≤ 3 cm in greatest dimension

_ _ _pN2: Metastasis in single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension

or in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

_ _ _pN2a: Metastasis in single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension

_ _ _pN2b: Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

_ _ _pN2c: Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

_ _ _pN3: Metastasis in lymph node > 6 cm in greatest dimension

Specify: Number examined: _ _ _ _ _ _ _ _ _

Number involved: _ _ _ _ _ _ _ _ _

^* Size (greatest dimension) of largest positive lymph node: _ _ _ _ _ _ _ _ _

Note: Metastases at level VII are considered regional lymph node metastases. Midline nodes are considered ipsilateral nodes

Distant metastasis (pM)

_ _ _Not applicable

_ _ _pM1: Distant metastasis

^* Specify site(s), if known: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

For mucosal malignant melanoma

_ _ _Primary tumor (pT)†

_ _ _pT3: Mucosal disease

_ _ _pT4a: Moderately advanced disease

Tumor involving deep soft tissue, cartilage, bone, or overlying skin

_ _ _pT4b: Very advanced disease

Tumor involving brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structures

Regional lymph nodes (pN)†

_ _ _pNX: Regional lymph nodes cannot be assessed

_ _ _pN0: No regional lymph node metastases

_ _ _pN1: Regional lymph node metastases present

_ _ _Distant metastasis (pM)†

_ _ _Not applicable

_ _ _pM1: Distant metastasis present

^* Specify site(s), if known: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Source of pathologic metastatic specimen† (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Additional Pathologic Findings (select all that apply)

^* _ _ _None identified

^* _ _ _Keratinizing dysplasia

^* _ _ _Mild

^* _ _ _Moderate

^* _ _ _Severe (carcinoma in situ)

^* _ _ _Nonkeratinizing dysplasia

^* _ _ _Mild

^* _ _ _Moderate

^* _ _ _Severe (carcinoma in situ)

^* _ _ _Inflammation (specify type): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _Squamous metaplasia

^* _ _ _Epithelial hyperplasia

^* _ _ _Colonization

^* _ _ _Fungal

^* _ _ _Bacterial

^* _ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Ancillary Studies (select all that apply)

_ _ _Human papillomavirus-associated carcinoma (p16 immunoreactivity, in situ hybridization, other)

_ _ _Present

_ _ _Negative

_ _ _Epstein-Barr virus (Epstein-Barr virus encoded RNA [EBER], other)

_ _ _Present

_ _ _Negative

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

^* Clinical History (select all that apply)

^* _ _ _Neoadjuvant therapy

^* _ _ _Yes (specify type): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _No

^* _ _ _Indeterminate

^* _ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* 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. †These phrases include clinical findings required for AJCC staging. This clinical information may be unknown to the pathologist. It is included here only for the sake of completeness. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Carcinomas of the Pharynx.” Web posting date October 2009, www.cap.org. Protocol applies to all invasive carcinomas of the pharynx (nasopharynx, oropharynx, hypopharynx) including the base of tongue, tonsils, soft palate, and uvula. Mucosal malignant melanoma is included. Lymphomas and sarcomas are not included.