7.0

Date specimen taken

Details the date the pathological specimen was taken to enable cross-referencing with the surgical procedures performed.

The date on which the specimen was extracted.

7.1

ENCDv4.5b (8.10)

Histological diagnosis

To determine the incidence of tumours of different histology and behaviour for epidemiological purposes.

A morphology code providing increased specificity for neoplasm recorded under diagnosis.

Refer to morphology code as in the extract of the International Classifications of Diseases for Oncology on "Morphology of Neoplasms" in ICD10.

*Permissible grouped values and labels will be dependent upon the output specifications.

7.2 ENCDv4.5b (8.11)

Grade of differentiation

Prognostic factor. This field records the histopathological grade of the tumour as found in the specimen presented for examination. In tumours containing several areas of different grade, the grade of the predominant component should be recorded. For the majority of tumours (squamous carcinomas, adenosquamous carcinomas, adenocarcinomas and transitional cell carcinomas) the UICC (International Union Against Cancer) differentiation grading system should be used. Also enables survival analysis i.e. survival by grade.

Qualitative assessment of the differentiation of the tumour expressed as the extent to which a tumour resembles the normal tissue at that site.

Permissible values are agreed by the clinical steering groups and conform to the requirements of the reporting output specifications. Currently there is no explicit requirement to map to terminologies or classifications. This will be kept under review.

•     Grade of differentiation is not appropriate or cannot be assessed

•     Well differentiated

•     Moderately differentiated

•     Poorly differentiated

•     Undifferentiated/anaplastic

7.3

ENCDv4.5b (8.16)

T (Tumour) category (pathological)

To allow for the pathological T (Tumour) stage to be taken into account in the analysis of treatment and outcome.

Post surgical staging: the extent of the primary tumour after excision of the primary cancer. This is derived from Local Invasion - Tumour Extent and Structure (s) Invaded data items on the Pathology dataset.

Refer to UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Classifications of Malignant Tumours

7.4 ENCDv4.5b (8.17)

N (Node) category (pathological)

To allow for the pathological N (Node) stage to be taken into account in the analysis of treatment and outcome.

The histological evidence of the absence or presence and extent of regional lymph node metastases. This is derived from Local/Regional nodes positive, Other Nodes positive and Marker lymph node 1 positive data items on the Pathology dataset.

Refer to UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Classifications of Malignant Tumours

7.5

ENCDv4.5b (8.18)

M (Metastasis) category (pathological)

To allow for the pathological M (Metastasis) stage to be taken into account in the analysis of treatment and outcome.

The histological evidence of the absence or presence of distant metastases. This is derived from the Distant Metastases data item on the Pathology dataset.

Refer to UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Classifications of Malignant Tumours

7.6

WBCA

pT1 (pathological) tumours – Haggitt level (polypoid tumours)

To monitor the anticipated increase of T1 (Tumour 1) lesions and to be taken into account in the analysis of treatment and outcome. Required for submission to the Welsh Bowel Cancer Clinical Audit for screening.

The level of invasion into the stalk of the polyp.

Refer to Haggitt Level Classification

7.7

WBCA

pT1 (pathological) tumours – Kikuchi level (sessile / flat tumours)

To monitor the anticipated increase of T1 (Tumour 1) lesions and to be taken into account in the analysis of treatment and outcome. Required for submission to the Welsh Bowel Cancer Clinical Audit for screening

The level of sub mucosal infiltration of the pathological T1 tumour. 

Refer to JRSGC JCGC (Japanese Research Society for Gastric Cancer Japanese Classification of Gastric Cancer)

7.8

NBOCAP

WBCA

Extramural venous invasion

To allow extramural venous invasion to be taken into account in the analysis of treatment and outcome. Required for submission to the Welsh and National Bowel Cancer Clinical Audit.

Records the presence of cancer cells within vascular spaces. Definite invasion of endothelium-lined vascular spaces in the submucosa is generally regarded as a significant risk for lymph node or distant metastasis.

•     Yes

•     No

7.9

NBOCAP

WBCA

CCI

Nodes examined number

To determine the median number of lymph nodes examined in resected specimens. Required for submission to the Welsh and National Bowel Cancer Clinical Audits and the information requirements of the bowel cancer clinical indicators.

The number of local/regional nodes examined and reported. Local/regional nodes are defined by the UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Atlas and vary with the primary cancer site

7.10

NBOCAP

WBCA

Nodes positive number

To determine the percentage of node positive patients. Required for staging (pN) pathological nodes and for submission to the Welsh and National Bowel Cancer Clinical Audits and the information requirements of the bowel cancer clinical indicators.

The number of local/regional nodes reported as being positive for the presence of tumour metastases. Local/regional nodes are defined by the UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Atlas and vary with the primary cancer site.

7.11

NBOCAP

WBCA

CCI

Non-peritonealised ‘circumferential’ margin – positivity

To determine the adequacy of any one excision in addition to determining the percentage and / or number of adequate excisions. Also required for submission to the Welsh and National Bowel Cancer Clinical Audits and the information requirements of the bowel cancer clinical indicators.

The minimum distance from the specimen margin to tumour is measured from histological slides, if this is less than or equal to 1 millimetre the margin is by definition involved. The distance in millimetres can then be reported through data item 7.12 below.

•     Yes

•     No

7.12

NBOCAP

WBCA

CCI

Non-peritonealised ‘circumferential’ margin – distance

To determine the adequacy of the excision. Also required for submission to the Welsh and National Bowel Cancer Clinical Audits and the information requirements of the bowel cancer clinical indicators.

The distance in millimetres between the tumour and the nearest circumferential excision margin, from where the positivity has been reported.

Millimetres

7.13

NBOCAP

WBCA

CCI

Cut specimen margin (including tissue doughnut)

To determine the adequacy of the excision. Also required for submission to the Welsh and National Bowel Cancer Clinical Audits and the information requirements of the bowel cancer clinical indicators.

The positivity of the margin from the cut end of the specimen including doughnut tissues, if tumour is macroscopically <30mm from the proximal or distal margins.

•     Yes

•     No

7.14

NBOCAP

WBCA

Dukes’ staging classification

To allow for the clinical/pathological staging by the MDT to be taken into account in the analysis of treatment and outcome. Required for submission to the Welsh and National Bowel Cancer Clinical Audits.

Dukes’ staging are defined by the UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Atlas and vary with the primary cancer site.

Refer to UICC (International Union Against Cancer) TNM (Tumour, Node and Metastasis) Classifications of Malignant Tumours

7.15

CCI

Plane of surgical excision (rectal only)

Management, audit and outcomes, also required for submission to the Welsh and National Bowel Cancer Clinical Audits and the information requirements of the bowel cancer clinical indicators.

Macroscopic assessment of plane of excision, definitions as per the Royal College of Pathologists dataset are as follows:

•     Mesorectal fascia plane: smooth surface no defect > 5 millimetres.  Good bulk to mesorectum & no coning near the tumour.

•     Intramesorectal plane: irregular mesorectal surface, muscularis propria not visible except at levator insertion, moderate coning distally

•     Muscularis propria plane: irregular surface with deep cuts & tears some of which extend to the muscularis propria, little bulk to mesorectum.

Permissible values are agreed by the clinical steering groups and conform to the requirements of the reporting output specifications. Currently there is no explicit requirement to map to terminologies or classifications. This will be kept under review.

•     Mesorectal fascia plane

•     Intramesorectal plane

•     Muscularis propria plane

7.16

WBCA

Response to neo-adjuvant therapy

There is preliminary evidence that completely excised rectal carcinomas that have received pre-operative neo-adjuvant chemo-radiotherapy that has resulted in complete or marked regression have a better prognosis than those without significant regression, also required for submission to the Welsh Bowel Cancer Clinical Audit.

Treatment given as a first step to shrink a tumour prior to the commencement of the main treatment.

Permissible values are agreed by the clinical steering groups and conform to the requirements of the reporting output specifications. Currently there is no explicit requirement to map to terminologies or classifications. This will be kept under review.

•     No residual tumour cells and / or mucus lakes only

•     Minimal residual tumour

•     No marked regression