Σταδιοποίηση Καρκινοειδούς Σκωληκοειδούς Απόφυσης

Καρκινοειδές Σκωληκοειδούς Απόφυσης

AJCC Stages

Stages

T

N

M

I

T1

N0

M0

II

T2

N0

M0

T3

N0

M0

III

T4

N0

M0

Any T

N1

M0

IV

Any T

Any N

M1

(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

T1

Tumor ≤ 2 cm in greatest dimensions

T1a

Tumor ≤ 1 cm in greatest dimensions

T1b

Tumor > 1 cm but ≤ 2 cm in greatest dimensions

T2

Tumor > 2 cm but ≤ 4 cm or with extension to the cecum

T3

Tumor > 4 cm or with extension to the ileum

T4

Tumor directly invades other adjacent organs or structures, e.g., abdominal wall and skeletal muscles*

Tumor that is adherent to other organs or structures, grossly, is classified cT4. However, if no tumor is present in the adhesion, microscopically, the classification should be pT1-3 depending on the anatomical depth of wall invasion. 
*Penetration of the mesoappendix does not seem to be as important a prognostic factor as the size of the primary tumor and is not separately categorized.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

• Rare in tumors < 2 cm
• Can invade cecum, terminal ileum, abdominal wall, and pelvic side wall

Nodal metastases

• Lymph node metastases are rare in small tumors
  • Found in up to 30% of tumors > 2 cm
• Appendix drains into retrocecal  and ileocolic nodes, eventually, to superior mesenteric nodes

Distant metastases

• Rare, occurring in only 0.7% of cases
• More common when lesions are > 2 cm in diameter
• Liver is primary site of metastatic disease

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Carcinoid tumor
• Well-differentiated neuroendocrine tumor
• Tubular carcinoid

• Goblet cell carcinoid
  • Classified according to staging scheme for appendiceal carcinoma
  • Also called adenocarcinoid
• Atypical carcinoid