The pancreas (all sections) is considered a single organ. The liver and gallbladder are also considered individual organs.
Review the record of a liver cancer carefully; primary hepatoma is uncommon in the United States and the liver is a common site of metastases from other organ primaries. Abstract the case as a liver primary only if the attending physician and/or pathologist states that is a primary tumor in the liver.
A key to determining whether a liver tumor is primary or metastatic is the presence of single or multiple tumor nodules involving one or more lobes of the liver. Invasion of the hepatic artery, vena cava, or portal vein are also indications that the liver tumor is a primary.
The lobes of the liver are defined and separated by a plane projecting between the bed of the gallbladder and the inferior vena cava.
Exploratory laparotomy may provide the most information about extent of disease, since biliary tract disease is often non-resectable at the time of diagnosis.
Use TX if the primary tumor was excised at another facility and no information about tumor size is available.
Do not add together the sizes of pieces of tumor removed at biopsy and at resection. Use the largest size of tumor, even if this is from the biopsy specimen. If no size is stated, record as 999 in the field "Size of Tumor."
If a partial resection of an organ is performed for diagnosis and a more complete procedure, such as a complete pancreatectomy, is done as cancer directed surgery, code the more complete surgical procedure. The surgical code should indicate the status of the primary organ at the completion of the procedure.
Invasion from the gallbladder into the liver is considered regional extension.
For purposes of AJCC staging, adjacent organs for the gallbladder include stomach, duodenum, colon, pancreas, omentum, extrahepatic bile ducts and liver.
For purposes of AJCC staging, adjacent organs for the extrahepatic bile ducts include stomach, duodenum, colon, pancreas, gallbladder, and liver.
Only about 20% of pancreatic cancers are localized at the time of diagnosis.
Low stage gallbladder cancer is usually discovered as an incidental finding after cholecystectomy for other reasons.
In order to AJCC stage a case, the size of the tumor must be recorded for liver and pancreas cancers.