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Colon Case Read the following patient information: Chief Complaint- 2-3 months fatigue and generalized weakness. Found to be severely anemic. Guaiac test positive for intestinal bleeding. Referred for investigation of suspected right colon cancer. Physical Examination- m Patient is obese with soft abdomen, 8cm mobile mass in right upper quadrant of the abdomen in region of ascending colon and hepatic flexure. There is no hepatomegaly. Imaging- 8-27-2021 Barium Enema: Large filling defect in ascending colon proximal to hepatic flexure. This is suspicious for carcinoma and colonoscopy is recommended. Remainder of colon otherwise negative. Endoscopy 9-8-2021 Complete colonoscopy shows large, hemorrhagic semi-circumferential mass beginning just after hepatic flexure. Some difficulty passing scope past angulation and lesion. No biopsies taken due to technical problems. Laboratory Reports- 9-14-2021 CEA= 178.0 (normal value is <2.5); Alkaline phosphatase, LDH increased. (Outside reports show this present in the past.) Operative Report- 9-17-2021 Exploratory lap, right hemicolectomy with in-continuity resection of segment of liver. lleotransverse colostomy. Findings: Exploration of abdominal cavity revealed large ascending colon mass widely adherent to the lateral peritoneum and undersurface of right liver. Extensive intraoperative evaluation of remainder of liver indicated no parenchymal nodules. Remainder of exploration indicated no evidence of metastatic disease. Pathology Report- 9-17-2021 Right hemicolectomy: Moderately-differentiated adenocarcinoma of the upper ascending colon (9x5.5cm) with invasion of muscularis propria and extension 8mm into right lobe of liver. Extensive lymphoid reaction around tumor. No lymphovascular or perineural invasion. Two of seven pericolic lymph nodes and one of three ileocolic lymph nodes positive for metastatic adenocarcinoma. Lines of resection free of tumor.

For questions 1-3, use the ICD-O-3 manual to choose the best answer- 1. The site code for the colon primary is: a. C18.0 C. C18.4 b. C18.2 d. C18.9 2. The histology code is: 8140 a. c. 8130 d. 8000 b. 8300 3. Behavior code: a. 0 b. 1 c. 2 d. 3 4. Pathologic grade code: (use Grade Coding manual) C. 3 b. 2 d. 4 a. 1 5. Lymphovascular invasion: (use the STORE manual pages 146-150) a. 0 c. 9 b. 1 d. not applicable 6. How many primaries? (use the Solid Tumor Rules manual) a. 1 b. 2 7. Using the Summary Stage 2018 manual, choose the best answer: a. 2 C. 4 b. 3 d. 9 8. Using the AJCC manual, choose the Clinical TNM: a. CTX CNX CMO C. CT2 CNX CMO b. CTX CN1 CMO d. CT2 CN1 CMO 9. Using the AJCC manual, choose the Pathologic TNM: a. pT2 pN1 CMO c. pT4b pN1 CMO b. PT2 pNlb CMO d. pT4b pN1b CMO

Use the SSDI Manual to answer questions 10-16: 10. CEA Pretreatment Lab Value: 0.0 a. C. 178.0 d. XXXX.9 b. 1780. 11. CEA Pretreatment Interpretation: 0 c. 2 b. 1 d. 9 a. 12. Circumferential Resection Margin: a. 0.0 c. XX.7 b. XX.O d. XX.9 13. KRAS: a. 0 c. 7 d. 9 b. 1 14. Microsatellite Instability (MSI): a. 0 b. 2 c. 8 d. 9 15. Perineural Invasion: a. 0 b. 1 C. 8 d. 9 16. Tumor Deposits: a. 00 b. X1 8 c. X8 d. X9