Gastrointestinal

Question 1

Ampulla of vater

Answer 1

_pT1a: limited to ampulla or sphincter of Oddi
_pT1b: invades beyond sphincter of Oddi (perisphincteric invasion) and / or into the duodenal submucosa
_pT2: invades muscularis propria of the duodenum
_ pT3a: invades pancreas (up to 0.5 cm)
_pT3b: extends more than 0.5 cm into the pancreas, or beyond without involvement of the celiac axis or superior mesenteric artery
_pT4: Tumor involves the celiac axis, superior mesenteric artery, and / or common hepatic artery,
irrespective of size

Question 2

Anus

Answer 2

_pT1: <= 2 cm
_pT2: >2 cm but <= 5 cm
_pT3: >5 cm in greatest dimension
_ pT4: any size invading adjacent organ(s), such as the vagina, urethra, or bladder

Question 3

Appendix

Answer 3

pTis (LAMN): Low-grade appendiceal mucinous neoplasm confined to the muscularis propria;
_pT1: invades submucosa
_ pT2: invades muscularis propria
_pT3: invades through the muscularis propria into the subserosa or the mesoappendix
_ pT4a: Tumor invades through the visceral peritoneum, including the acellular mucin or mucinous epithelium involving the serosa of the appendix or serosa of the mesoappendix
_ pT4b: Tumor directly invades (or adheres to###) adjacent organs or structures

Question 4

Colon and rectum

Answer 4

_pT1: invades the submucosa
_pT2: invades the muscularis propria
_pT3: invades through the muscularis propria into pericolorectal tissues
_pT4a: invades through the visceral peritoneum
pT4b: Tumor directly invades# or adheres## to adjacent organs or structures

Question 5

Distal extrahepatic bile duct

Answer 5

_pTis: Carcinoma in situ / HGD
_pT1: invades wall with a depth < 5 mm
_pT2: invades wall with a depth of 5-12 mm
_pT3: invades wall with a depth > 12 mm
_pT4: Tumor involves the celiac axis, superior mesenteric artery, and / or common hepatic artery

Question 6

Esophagus

Answer 6

_pT1a: invades lamina propria or muscularis mucosae
_pT1b: invades the submucosa
_pT2: invades the muscularis propria
_pT3: Tumor invades adventitia
_ pT4a: Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum
_ pT4b: Tumor invades other adjacent structures, such as the aorta, vertebral body, or airway

Question 7

Gallbladder

Answer 7

pT1a: invades the lamina propria
pT1b: invades the muscular layer
pT2a: invades connective tissue on the peritoneal side
pT2b: invades the connective tissue on the hepatic side
pT3: Tumor perforates the serosa and / or directly invades the liver and / or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum or extrahepatic bile ducts
pT4: Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures

Question 8

Gist

Answer 8

_pT1: < 2 cm or less
_ pT2: > 2 cm but not more than 5 cm
_ PT3: >5 cm but not more than 10 cm
_ pT4: > 10 cm

Question 9

Hepatocellular carcinoma

Answer 9

_ pT1a: Solitary <= 2 cm
_pT1b: Solitary > 2 cm
_ pT2: Solitary > 2 cm with vascular invasion, or multiple tumors, none > 5 cm
_PT3: Multiple tumors, at least one of which is > 5 cm
_pT4: involves a major branch portal vein or hepatic vein, or adjacent organs or with perforation of visceral peritoneum

Question 10

Intrahepatic bile duct

Answer 10

_pT1a: Solitary <=5 cm, no vascular invasion

_pT1b: Solitary > 5 cm no vascular invasion

_pT2: Solitary with intrahepatic vascular invasion or multiple

_pT3: perforating serosa

_pT4: direct invasion local extrahepatic structures

Question 11

Pancreas (exocrine)

Answer 11

_ pT1a: <= 0.5 cm
_pT1b: > 0.5 cm and < 1 cm
_pT1c: Tumor 1-2 cm
_pT2: > 2 cm and <= 4 cm
_pT3: > 4 cm
_pT4: Tumor involves the celiac axis or the superior mesenteric artery, and / or common hepatic artery, regardless of size

Question 12

Perihilar bile duct

Answer 12

_pT1: confined to bile duct, with extension up to the muscle layer or fibrous tissue
_ p2Ta: invades beyond the wall of bile duct to adipose tissue
_pT2b: invades adjacent hepatic tissue
_pT3: invades unilateral branches of portal vein or hepatic artery
_pT4: invades main portal vein or its branches bilaterally, or the common hepatic artery

Question 13

Small intestine

Answer 13

_pT1a: invades lamina propria
_pT1b: invades submucosa
_pT2: invades muscularis propria
_pT3: invades into the subserosa, or extends into nonperitonealized perimuscular tissue (mesentery or retroperitoneum) without serosal penetration
_pT4: perforates the visceral peritoneum or directly invades other organs or structures

Question 14

Stomach

Answer 14

_p1Ta: invades lamina propria or muscularis mucosae
_pT1b: invades the submucosa
_pT2: invades the muscularis propria
_pT3: penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures
_pT4a: Tumor invades the serosa
_pT4b: Tumor invades adjacent organs