Upper Aerodigestive Tract (Including Salivary Glands) Protocol applies to all invasive carcinomas of the upper aerodigestive tract including the oral cavity (including lip and tongue), pharynx

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Upper Aerodigestive Tract (Including Salivary Glands)

Protocol applies to all invasive carcinomas
of the upper aerodigestive tract including the oral cavity (including lip and tongue), pharynx (oropharynx, hypopharynx, nasopharynx), larynx, paranasal sinuses, and salivary glands.

Protocol revision date: January 2004

Based on AJCC/UICC TNM, 6th edition


Cytology (No Accompanying Checklist)




Ben Z. Pilch, MD

Department of Pathology, Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts

Elizabeth Gillies, MD

Department of Pathology, VA Medical Center, Oklahoma City, Oklahoma

John R. Houck Jr, MD

Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Kyung-Whan Min, MD

Department of Pathology, Deaconess Hospital, Oklahoma City, Oklahoma

David Novis, MD

Department of Pathology, Wentworth-Douglass Hospital, Dover, New Hampshire

Jatin Shah, MD

Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York

Richard J. Zarbo, MD, DMD

Department of Pathology, Henry Ford Hospital, Detroit, Michigan

For the Members of the Cancer Committee, College of American Pathologists
Surgical Pathology Cancer Case Summary (Checklist)

Protocol revision date: January 2004

Applies to invasive cancers only

Based on AJCC/UICC TNM, 6th edition


Patient name:

Surgical pathology number:
Note: Check 1 response unless otherwise indicated.


Specimen Type

___ Incisional biopsy

___ Excisional biopsy

___ Resection (specify type): ____________________________

___ Other (specify): ____________________________

___ Not specified

Tumor Site

___ Lip

___ Oral cavity

___ Pharynx, oropharynx

___ Pharynx, hypopharynx

___ Pharynx, nasopharynx

___ Larynx, supraglottis

___ Larynx, glottis

___ Larynx, subglottis

___ Paranasal sinus(es), maxillary

___ Paranasal sinus(es), ethmoid

___ Other (specify): ____________________________

___ Not specified

Tumor Size

Greatest dimension: ___ cm

*Additional dimensions: ___ x ___ cm

___ Cannot be determined (see Comment)


Histologic Type

Carcinomas of the Upper Aerodigestive Tract

___ Squamous cell carcinoma, conventional

Squamous Cell Carcinoma, Variant

___ Verrucous carcinoma

___ Spindle cell squamous carcinoma

___ Adenosquamous carcinoma

___ Basaloid squamous cell carcinoma

___ Papillary squamous cell carcinoma
___ Lymphoepithelioma-like carcinoma (non-nasopharyngeal)

Sinonasal Carcinoma

___ Keratinizing sinonasal carcinoma

___ Non-keratinizing sinonasal carcinoma (Transitional type)

___ Undifferentiated sinonasal carcinoma (SNUC)

Nasopharyngeal Carcinoma

___ Keratinizing nasopharyngeal carcinoma

___ Non-keratinizing nasopharyngeal carcinoma

___ Non-keratinizing nasopharyngeal carcinoma, differentiated

___ Non-keratinizing nasopharyngeal carcinoma, undifferentiated (lymphoepithelioma)

___ Non-keratinizing nasopharyngeal carcinoma, mixed differentiated and undifferentiated
___ Adenocarcinoma, salivary gland type (specify type): _________________________

Adenocarcinoma, Non-salivary Gland Type

___ Papillary adenocarcinoma

___ Intestinal-type adenocarcinoma

___ Adenocarcinoma, not otherwise specified (NOS)

Neuroendocrine carcinoma

___ Typical carcinoid tumor (well differentiated neuroendocrine carcinoma)

___ Atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma)

___ Small cell carcinoma (poorly differentiated neuroendocrine carcinoma)
___ Other (specify): ____________________________

___ Carcinoma, type cannot be determined

Carcinomas of Minor Salivary Glands

___ Acinic cell carcinoma

___ Adenoid cystic carcinoma

___ Adenocarcinoma, not otherwise specified (NOS)

___ Adenocarcinoma, low grade

___ Adenocarcinoma, intermediate grade

___ Adenocardinoma, high grade

___ Adenosquamous carcinoma

___ Squamous cell carcinoma

___ Carcinoma ex pleomorphic adenoma (malignant mixed tumor)

___ Carcinosarcoma (true malignant mixed tumor)

___ Mucoepidermoid carcinoma, low grade

___ Mucoepidermoid carcinoma, intermediate grade

___ Mucoepidermoid carcinoma, high grade

___ Polymorphous low-grade adenocarcinoma

___ Epithelial-myoepithelial carcinoma

___ Basal cell adenocarcinoma

___ Sebaceous carcinoma

___ Cystadenocarcinoma

___ Mucinous carcinoma (colloid carcinoma)

___ Oncocytic carcinoma

___ Salivary duct carcinoma

___ Myoepithelial carcinoma (malignant myoepithelioma)

___ Small cell carcinoma

___ Undifferentiated carcinoma

___ Other (specify): ____________________________

___ Carcinoma, type cannot be determined

Histologic Grade

___ Not applicable

___ GX: Cannot be assessed

___ G1: Well differentiated

___ G2: Moderately differentiated

___ G3: Poorly differentiated

___ Other (specify): ____________________________

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