Σταδιοποίηση σε Ca Σκωληκοειδούς Απόφυσης

Ca Σκωληκοειδούς Απόφυσης

AJCC Stages

Stages

T

N

M

G

0

Tis

N0

M0

I

T1

N0

M0

T2

N0

M0

IIA

T3

N0

M0

IIB

T4a

N0

M0

IIC

T4b

N0

M0

IIIA

T1

N1

M0

T2

N1

M0

IIIB

T3

N1

M0

T4

N1

M0

IIIC

Any T

N2

M0

IVA

Any T

N0

M1a

G1

IVB

Any T

N0

M1a

G2, G3

Any T

N1

M1a

Any G

Any T

N2

M1a

Any G

IVC

Any T

Any N

M1b

Any G

(R) Residual Tumor

R0

Complete resection, margins histologically negative; no residual tumor left after resection

R1

Incomplete resection, margins histologically involved, microscopic tumor remains after resection of gross disease (relevant to resection margins that are microscopically involved by tumor)

R2

Incomplete resection, margins involved or gross disease remains

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ: Intraepithelial or invasion of lamina propria¹

T1

Tumor invades submucosa

T2

Tumor invades muscularis propria

T3

Tumor invades through muscularis propria into subserosa or into mesoappendix

T4

Tumor penetrates visceral peritoneum, including mucinous peritoneal tumor within the right lower quadrant &/or directly invades other organs or structures²,³

T4a

Tumor penetrates visceral peritoneum, including mucinous peritoneal tumor within the right lower quadrant

T4b

Tumor directly invades other organs or structures

¹Tis includes cancer cells confined within the glandular basement membrane (intraepithelial) or lamina propria (intramucosal) with no extension through muscularis mucosae into submucosa. 
²Direct invasion in T4 includes invasion of other segments of the colorectum by way of the serosa, e.g., invasion of ileum. 
³Tumor that is adherent to other organs or structures, grossly, is classified cT4b. However, if no tumor is present in the adhesion, microscopically, the classification should be pT1-3 depending on the anatomical depth of wall invasion.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in perirectal lymph node(s)

N2

Metastasis in unilateral internal iliac &/or inguinal lymph node(s)

N3

Metastasis in perirectal and inguinal lymph nodes &/or bilateral internal iliac &/or inguinal lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

M1a

Intraperitoneal metastasis beyond the right lower quadrant, including pseudomyxoma peritonei

M1b

Nonperitoneal metastasis

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Χαρακτηριστικά Επέκτασης

Mucinous Ca

• Local spread
  • Peritoneal dissemination
    • Major route of spread of appendiceal mucinous tumors
    • Results from mucocele rupture and dissemination of malignant cells into peritoneal cavity
    • Distribution in peritoneal cavity follows expected peritoneal fluid hemodynamics and gravity
    • But tends to spare bowel due to peristalsis
• Nodal metastasis
  • Only 2% of patients have metastatic regional lymph nodes
  • Regional lymph nodes: Ileocolic nodes
• Hematogenous metastasis
  • Rare in contrast to colorectal carcinoma
  • Only 2% of patients have liver metastasis

Non Mucinous Ca

• Local spread
  • Tends to spread by direct invasion of surrounding structures
• Nodal metastasis
  • Behaves more like colorectal carcinoma, metastasizing early to regional lymph nodes
• Hematogenous metastasis

• Behaves more like colorectal carcinoma, with high propensity to metastasize to liver

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Mucinous carcinoma, colloid type (37%)
  • > 50% of mucinous Ca is of colloid type
• Nonmucinous
  • Adenocarcinoma in situ
  • Adenocarcinoma
    • Referred to as "colonic-type" adenocarcinoma of appendix

• Medullary carcinoma
• Signet ring cell Ca (> 50% signet ring cells)
• Squamous cell carcinoma
• Adenosquamous carcinoma
• Small cell carcinoma
• Undifferentiated carcinoma
• Carcinoma, NOS