1. Colon AJCC Case Answers

2. Colon Case 1 Answers Topography: C18.5 Histology: 8263/3
This case is one primary per rule M2
Clinical Staging cT
pTis cN cM
Clinical Stage Group
Pathological Staging pT 2 pN pM
cM0
Pathologic Stage Group 1
SEER Summary Stage: 1 - Localized
Rationale for staging choices
The rule for carcinoma in-situ is pTis, N0, M0. Clinical stage would be 0. There is a technical advisory group composed of NPCR, SEER, CoC, and AJCC. They are trying to bridge the gap between what AJCC says to assign and uses to assign versus what an abstractor has to code in a registry. This isn’t final yet and may only be a solution for 2016, but this will get us through until the 8th edition where they may want to approach it differently, but most software doesn’t accommodate blanks.
Tumor invading the superficial muscularis propria would be pT2, Lymph nodes negative = N0, No signs or symptoms of mets = M0

3. Colon Case 2 Answers Topography: C18.4 Histology: 8140/3
This case is one primary per rule M2
Clinical Staging cT X cN cM
pM1a
Clinical Stage Group
IVA
Pathological Staging pT 3 pN 2a pM 1b
Pathologic Stage Group
IVB
SEER Summary Stage: 7 - Distant
Rationale for staging choices
Not enough info to assign clinical T or N, so TX, NX. M is based on supraclavicular ln bx which is pM1a. Clinical stage IVA. The critical thing to make something clinical or pathologic is not only the method obtained, but also the timing rules. For example if a scan is done after the first surgery, that is something clinic but is done after the first surgery. You can use a clinical M0 and M1 only if the criteria for pathological staging has been met.
Tumor through muscularis propria and into pericolonic soft tissue = T3, 5 region ln involved = N2a, M1b bc of distant nodal mets and liver mets. Stage group IVB.