colon pN stage question

[gorillamunch]

What is the pN stage of a colon adenocarcinoma with a tumor nodule in 1 block, a positive lymph node in another block, and 11 negative lymph nodes?

Thanks in advance for the answer, and a reference or link would be greatly appreciated.

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[Alteran]

Per the CAP staging protocols for colorectal adenoCAs (page 25), tumor deposits without histologic evidence of residual lymph node tissue are not counted as a positive lymph node. Your stage is pN1a, but when you fill out the CAP protocol you will mention the tumor deposit.

 

[schrute]

I think the SEER data shows a difference of survival within N1 (and N2) groups, but part of that is reliant on the T stage. EG: most N1 tumors are stage IIIA or IIIB (regardless of the N being a, b or c), but a T4b any N bumps it up to IIIC.

 

[AZpath]

What is the pN stage of a colon adenocarcinoma with a tumor nodule in 1 block, a positive lymph node in another block, and 11 negative lymph nodes?

Thanks in advance for the answer, and a reference or link would be greatly appreciated.

A tumor deposit makes it N1c

 

[path19]

Alteran is correct, AZpath is not. The positive node makes it N1a. N1c is reserved only for cases where there are tumor deposits but no positive nodes.

 

[deleted314957]

I've been retired for a bit but aren't tumor deposites without evidence of it having been a node considered vascular invasion and given a separate "V" designation?

 

[AZpath]

Agree with path19. I stand corrected.

You have to read the fine print . It is quite confusing since typically a higher number or letter , ie N1b verses N1c, implies higher staging and worse prognosis.

 

[ygdrasil]

AJSP's January issue has an article touching on this: Jin, Ming MD, PhD et al.
The Impact of Tumor Deposits on Colonic Adenocarcinoma AJCC TNM Staging and Outcome
Survival appears to be modestly, but not significantly, worse for N1cs with >4 deposits than for N1a or N1b.