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{
"id" : "colon_65083",
"algorithm" : "tnm",
"version" : "1.6",
"name" : "Clin T Colon",
"title" : "Clinical T",
"notes" : "**Note 1:** High grade dysplasia and severe dysplasia of the colon are generally not reportable in cancer registries. \n* Assign pTis if your registry collects these tumors\n\n**Note 2:** In situ includes cancer cells confined within the glandular basement membrane (intraepithelial); localized includes confined to lamina propria (intramucosal), the muscular mucosa, and muscularis propria. \n\n**Note 3:** Ignore intraluminal extension to adjacent segment(s) of colon/rectum or to the ileum from the cecum; code depth of invasion or extracolonic spread as indicated.\n\n**Note 4:** Direct invasion in cT4b includes invasion of other organs or segments of the colorectum by way of the serosa, as confirmed on microscopic examination, or for tumors in a retroperitoneal or subperitoneal location, direct invasion of other organs or structures by virtue of extension beyond the muscularis propria. \n\n**Note 5:** Tumor that is adherent to other organs or structures, macroscopically, is classified T4b. However, if no tumor is present in the adhesion, microscopically, the classification should be pT1 - pT3.\n\n**Note 6:** Assign T4b for contiguous extension from the site of origin. Discontinuous involvement is coded in M (distant metastasis).",
"footnotes" : "\\# T4 [NOS] is not defined in AJCC 7th edition.",
"last_modified" : "2018-02-02T14:54:24.282Z",
"definition" : [ {
"key" : "clin_t",
"name" : "Clinical T",
"type" : "INPUT"
}, {
"key" : "clin_t_display",
"name" : "Clinical T Display",
"type" : "DESCRIPTION"
}, {
"key" : "description",
"name" : "Description",
"type" : "DESCRIPTION"
}, {
"key" : "notes",
"name" : "Registrar Notes",
"type" : "DESCRIPTION"
} ],
"rows" : [ [ "cX", "cTX", "Primary tumor cannot be assessed", "Clinical classification criteria met, evaluation done: \n Physician unable to assess T \n Extension cannot be determined\nPhysician assigns cTX, no other information available to determine T" ], [ "c0", "cT0", "No evidence of primary tumor", "No evidence of primary tumor" ], [ "pIS", "pTis", "Carcinoma in situ: intraepithelial or invasion of lamina propria", "(Adeno)carcinoma, noninvasive, in a polyp or adenoma\n\nInvasive tumor confined to:\n Lamina propria, including lamina propria in the stalk of a polyp\n Mucosa, NOS, including intramucosal, NOS\n Muscularis mucosae (but not through), including muscularis mucosae in the stalk of a polyp\n\nStated as Tis" ], [ "c1", "cT1", "Tumor invades submucosa", "Confined to: \n Head of polyp, NOS\n Stalk of polyp, NOS\n\nInvasive tumor in polyp, NOS\n\nInvades submucosa (superficial invasion), including submucosa in the head or stalk of polyp\n\nConfined to colon, NOS\nLocalized, NOS\n\nStated as T1" ], [ "c2", "cT2", "Tumor invades muscularis propria", "Stated as T2" ], [ "c3", "cT3", "Tumor invades subserosa or into non-peritionealized pericolic or perirectal tissues", "Extension through wall, NOS\nInvasion through muscularis propria or muscularis, NOS\nNon-peritonealized pericolic tissues invaded\nPerimuscular tissue invaded\nSubserosal tissue/(sub)serosal fat invaded\nTransmural, NOS\nWall, NOS\n\nExtension to:\n All colon sites:\n Adjacent tissue(s), NOS\n Connective tissue\n Mesenteric fat\n Mesentery \n Mesocolon\n Pericolic fat\n Ascending and descending colon\n Retroperitoneal fat \n Transverse colon and flexures\n Gastrocolic ligament\n Greater omentum\n\nFat, NOS\n\nStated as T3" ], [ "c4", "cT4", "Tumor perforates visceral peritoneum and/or directly invades other organs or structures#", "Note: T4 has subcategories of T4a and T4b. Assign T4 only when there is no information available to assign one of the subcategories\n\nStated as T4 [NOS]" ], [ "c4A", "cT4a", "Tumor perforates visceral peritoneum", "Invasion of/through serosa (mesothelium) (visceral peritoneum)\nTumor penetrates to surface of visceral peritoneum\n\nStated as T4a" ], [ "c4B", "cT4b", "Tumor directly invades other organs or structures", "Adherent to other organs or structures clinically with no microscopic examination\nTumor found in adhesion(s) if microscopic examination performed\n(see Note 5)\n\nContiguous extension to:\n\nAll colon sites:\n Abdominal wall\n Adrenal (suprarenal) gland\n Bladder\n Diaphragm\n Fallopian tube\n Fistula to skin\n Gallbladder\n Other segment(s) of colon via serosa\n Ovary\n Retroperitoneum \n Small intestine\n Uterus\n\nCecum (C180):\n Greater omentum\n Kidney\n Liver\n Ureter\n \nAscending colon (C182):\n Greater omentum\n Liver, right lobe\n Right kidney\n Right ureter\n \nTransverse colon and flexures (C183, C184, C185):\n Gallbladder/bile ducts\n Kidney\n Liver\n Pancreas\n Spleen\n Stomach\n Ureter\n \nDescending colon (C186):\n Greater omentum\n Left kidney\n Left ureter\n Pelvic wall\n Spleen\n \nSigmoid colon (C187):\n Cul de sac (rectouterine pouch)\n Greater omentum\n Pelvic wall\n Ureter\n\nStated as T4b (all colon subsites)" ], [ "88", "88", "Not applicable", "Primary site/histology not TNM defined\nDeath certificate only (DCO) case" ], [ "", "BLANK", "See Registrar Notes", "Clinical classification criteria not met \nClinical classification criteria met, evaluation done:\n No information about diagnostic workup\n Results not documented in record\nClinical evaluation of primary tumor not done or unknown if done\nTumor first detected on surgical resection (no clinical workup)\nEvidence of metastatic disease [(cM1) or (pM1)], no other workup\nOnly Clinical Stage Group documented (no T, N, or M information available)" ] ]
}
