Skip to main content

Colorectal Carcinoma

  • Chapter
  • First Online:
Histopathology Reporting
  • 1521 Accesses

Abstract

Colorectal Carcinoma: this chapter outlines the incidence, risk factors, clinical presentation, investigations, treatments and prognosis of cancer at this anatomical site. These features are correlated with the core data that are required to make the corresponding histopathology reports of a consistently high quality, available in an appropriate timeframe, and clinically relevant to patient management and prognosis. Summary details of the common cancers given at this site include: gross description, histological types, tumour grade/differentiation, extent of local tumour spread, lymphovascular invasion, lymph node involvement, and the status of excision margins. Current WHO Classifications of Malignant Tumours and TNM7 are referenced. Notes are provided on other associated pathology, contemporary use of immunohistochemistry, updates on the role of evolving molecular tests, and the use of these ancillary techniques as biomarkers in diagnosis, and prediction of prognosis and treatment response. A summary is given of the commoner non-carcinoma malignancies that are encountered at this site in diagnostic practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  • Allen DC. Histopathology reporting: guidelines for surgical cancer. 2nd ed. London: Springer; 2006.

    Google Scholar 

  • Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. Am J Surg Pathol. 2008;129:13–23.

    Google Scholar 

  • Bateman AC, Carr NJ, Warren BF. The retroperitoneal surface in distal caecal and proximal ascending colon carcinoma: the Cinderella surgical margin? J Clin Pathol. 2005;58:426–8.

    Article  CAS  PubMed  Google Scholar 

  • Bettington M, Walker N, Clouston A, Brown I, Leggett B, Whitehall V. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology. 2013;62:376–86.

    Article  Google Scholar 

  • Bosman FT, Carneiro F. WHO classification of tumours of the digestive system. 4th ed. Lyon: IARC press; 2010.

    Google Scholar 

  • Bull AD, Biffin AHB, Mella J, Radcliffe AG, Stamatakis JD, Steele RJC, Williams GT. Colorectal cancer pathology reporting: a regional audit. J Clin Pathol. 1997;50:138–42.

    Article  CAS  PubMed  Google Scholar 

  • Burroughs SH, William GT. Examination of large intestine resection specimens. J Clin Pathol. 2000;50:344–9.

    Article  Google Scholar 

  • Burroughs SH, Williams GT. ACP best practice no. 159. Examination of large-intestine resection specimens. J Clin Pathol. 2000;53:345.

    Article  Google Scholar 

  • Cairns SR, Scholefield JH, Steele RJ, British Society of Gastroenterology, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59:666–89.

    Article  PubMed  Google Scholar 

  • Chetty R. Gastrointestinal cancers accompanied by a dense lymphoid component: an overview with special reference to gastric and colonic medullary and lymphoepithelioma-like carcinomas. J Clin Pathol. 2012;65:1062–5.

    Article  PubMed  Google Scholar 

  • Cooper HS. Pathology of the endoscopically removed malignant colorectal polyp. Curr Diagn Pathol. 2007;13:423–37.

    Article  Google Scholar 

  • Cooper HS, Deppisch LM, Kahn EI, Lev R, Manley PN, Pascal RR, Qizilbash AH, Rickert RR, Silverman JF, Wirman JA. Pathology of the malignant colorectal polyp. Hum Pathol. 1998;29:15–26.

    Article  CAS  PubMed  Google Scholar 

  • Cotton P, Williams C. Practical gastrointestinal endoscopy. 4th ed. London: Blackwell Science; 1996.

    Google Scholar 

  • Cserni G, Bori R, Sejben I. Limited lymph-node recovery based on lymph-node localisation is sufficient for accurate staging. J Clin Pathol. 2011;64:13–5.

    Article  PubMed  Google Scholar 

  • Day DW, Jass JR, Price AB, Shepherd NA, Sloan JM, Talbot IC, Warren BF, Williams GT. Morson and Dawson’s gastrointestinal pathology. 4th ed. Oxford: Blackwell Sciences; 2003.

    Book  Google Scholar 

  • Dirschmid K, Sterlacci W, Oellig F, Edlinger M, Jasarevic Z, Rhomberg M, Dirschmid H, Offner F. Absence of extramural venous invasion is an excellent predictor of metastasis-free survival in colorectal carcinoma stage II – a study using tangential tissue sectioning. J Clin Pathol. 2012;65:619–23.

    Article  PubMed  Google Scholar 

  • Doyle VJ, Bateman AC. Colorectal cancer staging using TNM7: is it time to use this new staging system? J Clin Pathol. 2012;65:372–4.

    Article  CAS  PubMed  Google Scholar 

  • Dudley H, Pories W, Carter D, editors. Rob and Smith’s operative surgery: alimentary tract and abdominal wall. 4th ed. London: Butterworths; 1993.

    Google Scholar 

  • Dukes CE, Bussey HJR. The spread of rectal cancer and its effect on prognosis. Br J Cancer. 1958;12:309–20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Ensari A, Bosman FT, Offerhaus GJA. The serrated polyp: getting it right! J Clin Pathol. 2010;63:665–8.

    Article  CAS  PubMed  Google Scholar 

  • Ervine A, Houghton J, Park R. Should lymph nodes from colorectal cancer resection specimens be processed in their entirety? J Clin Pathol. 2012;65:114–6.

    Article  PubMed  Google Scholar 

  • Fielding LP, Goldberg SM, editors. Rob and Smith’s operative surgery: surgery of the colon, rectum and anus. Oxford: Elsevier Science Ltd; 2002.

    Google Scholar 

  • Finlay I. Preoperative staging for rectal cancer. Magnetic resonance imaging can accurately predict the success of surgical resection. BMJ. 2006;333:766–7.

    Article  PubMed  Google Scholar 

  • Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 454 cases. Recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol. 2002;26:179–89.

    Article  PubMed  Google Scholar 

  • Guidelines from the Bowel Cancer Screening Programme Pathology Group. Reporting lesions in the NHS Bowel Cancer Screening Programme; NHS BCSP Publication No 1. 2007.

    Google Scholar 

  • Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89:328–36.

    CAS  PubMed  Google Scholar 

  • Hurlstone DP, Brown S, Cross SS. The role of flat and depressed colorectal lesions in colorectal carcinogenesis: new insights for clinicopathological findings in high-magnification chromoscopic colonoscopy. Histopathology. 2003;43:413–26.

    Article  CAS  PubMed  Google Scholar 

  • Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology. 2007;50:113–30.

    Article  CAS  PubMed  Google Scholar 

  • Jones DJ, editor. ABC of colorectal diseases. 2nd ed. London: BMJ Books; 1999.

    Google Scholar 

  • Konishi F, Morson BC. Pathology of colorectal adenomas: a colonoscopic survey. J Clin Pathol. 1982;35:830–41.

    Article  CAS  PubMed  Google Scholar 

  • Littleford SE, Baird A, Rotimi O, Verbeke CS, Scott S. Interobserver variation in the reporting of local peritoneal involvement and extramural venous invasion in colonic cancer. Histopathology. 2009;55:407–13.

    Article  PubMed  Google Scholar 

  • Ludeman L, Shepherd NA. Macroscopic assessment and dissection of colorectal cancer resection specimens. Curr Diagn Pathol. 2006;12:220–30.

    Article  Google Scholar 

  • MacGregor TP, Maughan TS, Sharma RA. Pathological grading of regression following neoadjuvant chemoradiation therapy: the clinical need is now. J Clin Pathol. 2012;65:867–71.

    Article  PubMed  Google Scholar 

  • Makinen MJ. Colorectal serrated adenocarcinoma. Histopathology. 2007;50:131–50.

    Article  CAS  PubMed  Google Scholar 

  • Mann CV, Russell RCG, Williams NS, editors. Bailey & Love’s short practice of surgery. 22nd ed. London: Chapman and Hall Medical; 1995.

    Google Scholar 

  • McGregor DK, Wu TT, Rashid A, Luthra R, Hamilton SR. Reduced expression of cytokeratin 20 in colorectal carcinomas with high levels of microsatellite instability. Am J Surg Pathol. 2004;28:712–8.

    Article  PubMed  Google Scholar 

  • Mekenkamp LJM, van Krieken JHJM, Marijnen CAM, van de Velde CJH, Nagtegaal ID. Lymph node retrieval in rectal cancer is dependent on many factors – the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol. 2009;33:1547–53.

    Article  PubMed  Google Scholar 

  • Mitchard JR, Love SB, Baxter KJ, Shepherd NA. How important is peritoneal involvement in rectal cancer? A prospective study of 331 cases. Histopathology. 2010;57:671–9.

    Article  PubMed  Google Scholar 

  • Morson BC, Whiteway JE, Jones EA, Macrac FA, Williams CB. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut. 1984;25:437–44.

    Article  CAS  PubMed  Google Scholar 

  • Odze RD, Goldblum JR. Surgical pathology of the GI tract, liver, biliary tract and pancreas. 2nd ed. Philadelphia: Saunders/Elsevier; 2009.

    Google Scholar 

  • Pheby DFH, Levine DF, Pitcher RW, Shepherd NA. Lymph node harvests directly influence the staging of colorectal cancer: evidence from a regional audit. J Clin Pathol. 2004;57:43–7.

    Article  CAS  PubMed  Google Scholar 

  • Poston GJ, Tait D, O’Connell S, Bennett A, Berendse S, Guideline Development Group. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ. 2011;343:1010–2.

    Article  Google Scholar 

  • Prall F. Tumour budding in colorectal carcinoma. Histopathology. 2007;50:151–62.

    Article  CAS  PubMed  Google Scholar 

  • Pritchard CC, Grady WM. Colorectal cancer molecular biology moves into clinical practice. Gut. 2011;60:116–29.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Puppa G, Senore C, Sheahan K, et al. Diagnostic reproducibility of tumour budding in colorectal cancer: a multicentre, multinational study using virtual microscopy. Histopathology. 2012;61:562–75.

    PubMed  Google Scholar 

  • Quirke P. Training and quality assurance for rectal cancer: 20 years of data is enough. Lancet. 2004;4:695–701.

    Google Scholar 

  • Quirke P, Morris E. Reporting colorectal cancer. Histopathology. 2007;50:103–12.

    Article  CAS  PubMed  Google Scholar 

  • Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2:996–8.

    Article  CAS  PubMed  Google Scholar 

  • Quirke P, Williams GT, Ectors N, Ensari A, Piard F, Nagtegaal I. The future of the TNM staging system in colorectal cancer: time for a debate? Lancet Oncol. 2007;8:651–7.

    Article  PubMed  Google Scholar 

  • Riddell RH, Goldman H, Ransonoff DF, Appelman HD, Fenoglio CM, Haggitt RC, Ahren C, Correa P, Hamilton SK, Morson BC, Sommers SC, Yardley JH. Dysplasia in inflammatory bowel disease: standardised classification with provisional clinical applications. Hum Pathol. 1983;14:931–68.

    Article  CAS  PubMed  Google Scholar 

  • Riddell RH, Petras RE, Williams GT, Sobin LH. Tumors of the intestines. Atlas of tumor pathology. 3rd Series. Fascicle 32. Washington: AFIP; 2003.

    Google Scholar 

  • Ryan R, Gibbons D, Hyland JMP, Treanor D, White A, Mulcahy HE, O’Donoghue DP, Moriarty M, Fennelly D, Sheahan K. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47:141–6.

    Article  CAS  PubMed  Google Scholar 

  • Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5.

    Article  CAS  PubMed  Google Scholar 

  • Shepherd NA. Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol. 1991;44:726–33.

    Article  CAS  PubMed  Google Scholar 

  • Shepherd NA, Baxter KJ, Love SB. Influence of local peritoneal involvement on pelvic recurrence and prognosis in rectal cancer. J Clin Pathol. 1995;48:849–55.

    Article  CAS  PubMed  Google Scholar 

  • Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP. Serrated polyps of the large intestine. A morphologic and molecular review of an evolving concept. Am J Clin Pathol. 2005;124:380–91.

    Article  PubMed  Google Scholar 

  • Stewart CJR, Morris M, de Boer B, Iacopetta B. Identification of serosal invasion and extramural venous invasion on review of Dukes’ stage B colonic carcinomas and correlation with survival. Histopathology. 2007;51:372–8.

    Article  CAS  PubMed  Google Scholar 

  • Swamy R. Histopathological reporting of pT4 tumour stage in colorectal carcinomas: dotting ‘i’s and crossing ‘t’s. J Clin Pathol. 2010;63:110–5.

    Article  CAS  PubMed  Google Scholar 

  • Talbot IC, Ritchie S, Leighton M, Hughes AO, Bussey HJR, Morson BC. Invasion of veins by carcinoma of rectum: method of detection, histological features and significance. Histopathology. 1981;5:141–63.

    Article  CAS  PubMed  Google Scholar 

  • Talbot I, Price A, Salto-Tellez M. Biopsy pathology – colorectal disease. 2nd ed. London: Hodder Arnold; 2007.

    Google Scholar 

  • The Royal College of Pathologists: Cancer Datasets (Oesophageal Carcinoma, Gastric Carcinoma, Carcinomas of the Pancreas, ampulla of Vater and Common Bile Duct, Colorectal Cancer, Gastrointestinal Stromal Tumours (GISTs), Liver Resection Specimens and Liver Biopsies for Primary and Metastatic Carcinoma, Endocrine Tumours of the Gastrointestinal Tract including Pancreas) and Tissue Pathways (Gastrointestinal and Pancreatobiliary Pathology, Liver Biopsies for the Investigation of Medical Disease and for Focal Liver Lesions). Accessed at http://www.rcpath.org/index.asp?PageID=254.

  • Verhulst J, Ferdinande L, Demetter P, Ceelen W. Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis. J Clin Pathol. 2012;65:381–8.

    Article  CAS  PubMed  Google Scholar 

  • Wheeler JM, Warren BF, Mortensen NJ. Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system. Dis Colon Rectum. 2002;45:1051–6.

    Article  CAS  PubMed  Google Scholar 

  • Williams GT. Endocrine tumours of the gastrointestinal tract – selected topics. Histopathology. 2007;50:30–41.

    Article  CAS  PubMed  Google Scholar 

  • Xu F, Xu J, Lou Z, Di M, Wang F, Hu H, Lai M. Micropapillary component in colorectal carcinoma is associated with lymph node metastasis in T1 and T2 stages and decreased survivial time in TNM stages I and II. Am J Surg Pathol. 2009;33:1287–92.

    Article  PubMed  Google Scholar 

  • Yantiss RK. Serrated colorectal polyps and the serrated neoplastic pathway: emerging concepts in colorectal carcinongenesis. Curr Diagn Pathol. 2007;13:456–66.

    Article  Google Scholar 

  • Yao Y-F, Wang L, Liu Y-Q, Li J-Y, Gu J. Lymph node distribution and pattern of metastases in the mesorectum following total mesorectal excision using the modified fat clearing technique. J Clin Pathol. 2011;64:1073–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Allen, D.C. (2013). Colorectal Carcinoma. In: Histopathology Reporting. Springer, London. https://doi.org/10.1007/978-1-4471-5263-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5263-7_5

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5262-0

  • Online ISBN: 978-1-4471-5263-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics