Explanatory Notes for Oral Cancer Checklist
小組成員：
台安醫院病理科靳應台醫師 (召集人)
台大醫院病理部吳木榮醫師
林口長庚病理科容世明醫師
台北榮總病理部李永賢醫師
高雄長庚病理科黃昭誠醫師
參考資料:
(A). CAP-Cancer Protocols and Checklists: www.cap.org
(B).
1. Bone invasion
a. Bone invasion 應該可以放在 optional 區分 cortical erosion。
b. 根據 WHO Classification of Tumor：TNM classification of the oral cavity and oropharynx，有
關 oral carcinomas 的 bone invasion 之描述是"Tumor invades through cortical bone" ，又據
Dr. Woolgar 的 paper"Histopathological progrosticators in oral and oropharyngeal squamous
cell carcinoma "( Oral Ocology 2006,42:229-239)認為 bone involvement 是” penetration of
the mandibular or maxillary cortical plate to involve cancellous bone” ，而且 bone invasion 為
T4。WHO classification of Tumors 中也加註：”Superficial erosion alone of bone/tooth socket by
gingival primary is not sufficient to classify a tumor as T4”。因此 cortical bone erosion 不能算
bone invasion。
2. depth of invasion.
a.
Oral cancer 的 exophytic tumor 通常 invasion 深度是以旁邊的正常組織層作測量的依據,
有
micorinvasion (shallow)
verrucous invasion (shallow)
invasion of lamina propria or minor salivary glands (intermediate)
invasion of facial muscles or fascia, periosteum, bone etc. (deep)
invasion of skin (deep)
b. Exophytic tumor 之 invasion depth 與 infittrative tumor 的算法應相同，在顯微鏡下觀察
tumor invasion 的深度(到 submosal layer, masseter muscle, subcutaneous adipse layer, skin)。
--- Optional items --*Pathologic Staging: Stage
(pT N M
) (2009 AJCC 7th edition) (參閱附表二)
*Additional Pathologic Findings (select all that apply)
*___ None identified
*___ Keratinizing dysplasia, mild / moderate / severe
*___ Non-keratinizing dysplasia, mild / moderate / severe
*___ Inflammation, (specify) ____________________________
*___ Epithelial hyperplasia
*___ Colonization, fungal / bacteria
*___ Other: (specify) ____________________________
*Ancillary Studies
*Type(s): ____________________________
*Result(s): ____________________________
*Clinical History (select all that apply)
*___ Neoadjuvant therapy: yes / no / indeterminate
*___ Other: (specify) ____________________________
*Comment(s): _______________________________________________________
附表一 Histologic Type:
Variants of Squamous Cell Carcinoma
___ Squamous cell carcinoma, conventional
___ Acantholytic squamous cell carcinoma
___ Adenosquamous carcinoma
___ Basaloid squamous cell carcinoma
___ Carcinoma cuniculatum
___ Papillary squamous cell carcinoma
___ Spindle cell squamous carcinoma
___ Verrucous carcinoma
___ Lymphoepithelial carcinoma (non-nasopharyngeal)
Carcinomas of minor salivary glands
___ Acinic cell carcinoma
___ Adenoid cystic carcinoma
___ Adenocarcinoma, NOS, low / intermediate / high grade
___ Basal cell adenocarcinoma
___ Carcinoma ex pleomorphic adenoma (malignant mixed tumor)
low / high grade, invasive / minimally invasive / intracapsular (noninvasive)
___ Carcinoma, type cannot be determined
___ Carcinosarcoma
___ Clear cell adenocarcinoma
___ Cystadenocarcinoma
___ Epithelial-myoepithelial carcinoma
___ Mucoepidermoid carcinoma, low / intermediate / high grade
___ Mucinous adenocarcinoma (colloid carcinoma)
___ Myoepithelial carcinoma (malignant myoepithelioma)
___ Oncocytic carcinoma
___ Polymorphous low-grade adenocarcinoma
___ Salivary duct carcinoma
___ Other
Neuroendocrine carcinoma
___ Typical carcinoid tumor (well differentiated neuroendocrine carcinoma)
___ Atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma)
___ Small cell carcinoma (poorly differentiated neuroendocrine carcinoma)
___ Combined (or composite) small cell carcinoma, neuroendocrine type
附表二 Pathologic Staging (pTNM) (2009 AJCC 7th edition):
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple primary tumors)
___ r (recurrent)
___ y (post-treatment)
1. For All Carcinomas Excluding Mucosal Malignant Melanoma
Primary Tumor (pT)
___ pTX: Cannot be assessed
___ pT0:
No evidence of primary tumor
___ pTis: Carcinoma in situ
___ pT1:
___ pT2:
___ pT3:
___ pT4a:
Tumor 2 cm or less in greatest dimension
Tumor more than 2 cm but not more than 4 cm in greatest dimension
Tumor more than 4 cm in greatest dimension
Moderately advanced local disease.
Lip: Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or
skin of face, ie, chin or nose
Oral cavity: Tumor invades adjacent structures only (eg, through cortical bone
[mandible, maxilla], into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus,
palatoglossus, and styloglossus], maxillary sinus, skin of face)
___ pT4b:
Very advanced local disease. Tumor invades masticator space, pterygoid plates, or
skull base, and/or encases internal carotid artery
Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumor as T4.
Regional Lymph Nodes (pN)
___ pNX: Cannot be assessed
___ pN0:
No regional lymph node metastasis
___ pN1:
Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
___ pN2a: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm
in greatest dimension
___ pN2b:
___ pN2c:
Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest
dimension
Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest
___ pN3:
dimension
Metastasis in a lymph node more than 6 cm in greatest dimension
Note: Superior mediastinal lymph nodes are considered regional lymph nodes (level VII).
Midline nodes are considered ipsilateral nodes.
Distant Metastasis (pM)
___ Not Applicable
___ pM1: Distant metastasis
*Specify site(s), if known: ____________________________
* Source of pathologic metastatic specimen (specify): _______________
2. For Mucosal Malignant Melanoma
Primary Tumor (pT)
___ pT3:
Mucosal disease
___ pT4a: Moderately advanced disease. Tumor involving deep soft tissue, cartilage, bone, or
overlying skin
___ pT4b:
Very advanced disease. Tumor involving brain, dura, skull base, lower cranial nerves
(IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal
structures
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0:
No regional lymph node metastases
___ pN1:
Regional lymph node metastases present
Distant Metastasis (pM)
___ Not applicable
___ pM1: Distant metastasis present
*Specify site(s), if known: ____________________________
* Source of pathologic metastatic specimen (specify): _______________