How Ovarian Cancer Protocols Benefit Pathologists and Patients

• More information about the CAP Cancer Protocols
• For questions, please email us at CancerProtocols@cap.org.

Julie McDowell:

It's September, Ovarian Cancer Awareness Month. It's also a good opportunity to highlight the important role that cancer protocols play in patient care. The CAP Cancer Protocols, help ensure that all pathology reports contain necessary data elements to improve patient care. By requiring those specific data elements, synoptic reporting ensures more accurate reports that communicate findings in a clear standardized format to clinician colleagues, researchers, and other users of the data. Explain doctors, Barbara Crothers and Uma Krishnamurti, in this CAPcast interview.

In this episode, both pathologists will discuss how these cancer reporting protocols benefit thousands of CAP member pathologists, as well as other medical professionals, by ensuring complete uniform reporting of malignant tumors. Dr. Uma Krishnamurti, as I mentioned, September is Ovarian Cancer Awareness Month. Can you discuss what is covered by the CAP Protocol for patients with primary tumors of the ovarian, fallopian tube, or peritoneum?

Dr. Uma Krishnamurti:

The required major sections in the CAP Protocol of primary tumors of the ovary, fallopian tube, or peritoneum includes the type of surgical procedure performed, the organs and tissues removed during the surgical procedure. We also report on the integrity of the ovary, fallopian tube and uterus, which is important for staging. The primary tumor site, the size of the tumor, the grade of the tumor, the histologic type of tumor. We also record the extent to which the tumor involves sites other than the primary site, and the peritoneal fluid, which has been submitted. We also record plural fluid involvement, if it has been submitted. All this information which is collected, helps in more accurate tumor and lymph node categorization. As well as, FIGO staging, all of which in turn translates into better clinical care.

Julie McDowell:

Can you share what a pathologist should consider when using the Ovarian Protocol?

Dr. Uma Krishnamurti:

The Ovarian Protocol has both required elements, and optional elements. Reporting optional elements that are not required for laboratory accreditation will be very helpful in collecting data to further our knowledge about tumors. This additional information may also be valuable to the treating physician. Optional elements, help us make evidence-based changes to the protocols in the future and may also facilitate research. Our very popular explanatory notes and notes in the reporting sections, are a valuable and quick reference. However, they do not represent everything from our primary sources. Pathologists should refer to the primary sources as and when needed.

Julie McDowell:

And Dr. Krishnamurti, are there specific modifications to the protocol that help the pathologist in reporting?

Dr. Uma Krishnamurti:

Yes. In the recent protocols, we have reformatted the sections on lymph node and peritoneal surface involvement, that make it easier for pathologists using the electronic versions by answering fewer questions. The reformatted sections, still collect and report all necessary information, while still maintaining uniformity across all CAP Protocols.

Julie McDowell:

Dr. Crothers, the Ovarian Protocol was recently revised. What was updated in the June, 2021 version?

Dr. Barbara Crothers:

The major updates were the, histologic tumor types, the addition of ovarian sarcomas to the protocol. The addition of atypical and suspicious to the responses for body fluid involvement, and modification of the FIGO stages. In addition, the term implant now applies only to ovarian borderline tumors. And the presence of invasive implants, defines that tumor as a low-grade serous carcinoma.

Julie McDowell:

Can you also discuss the specific changes to the histologic types that you feel are important to highlight?

Dr. Barbara Crothers:

Yes. The histologic types mirror the changes in the updated fifth edition, of the World Health Organization book, on the classification of female genital tumors. Serous borderline tumors with microinvasion, is now distinguished from microinvasive low-grade serous carcinoma. And they're categorized by the major appearance of the tumor. Low-grade and high-grade ovarian serous carcinomas, are recognized as distinct tumor types rather than a spectrum, with different morphology, origins, and molecular signatures. In addition, seromucinous carcinoma, is now a subtype of endometrioid carcinoma. But seromucinous borderline tumor, remains as a distinct entity. What's interesting about these changes is that, the morphologic classification of tumors is continuously changing and incorporating molecular classification that facilitates our diagnosis and treatment.

Julie McDowell:

Finally, Dr. Crothers, in the context of patient care, why is the use of ovarian cancer protocols important?

Dr. Barbara Crothers:

Protocols allow us to speak a common language and collect the same data for all patients, thereby creating uniformity of tumor staging and ensuring appropriate patient care.

Julie McDowell:

Thank you both for discussing these cancer protocols. For more information on the CAP Cancer Protocols, please visit the protocols and guidelines section of www.cap.org.

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