Skip to main content
SpringerLink
Log in

Pathology and Staging of Rectal Cancer

  • Chapter
  • First Online:
Modern Management of Cancer of the Rectum

  • 1554 Accesses

Abstract

Treatment of rectal cancer requires multidisciplinary collaboration. Proper reporting and staging of rectal cancer specimens is indispensable for the management of rectal cancer. The work of pathologist over the years has substantially changed from merely providing an initial diagnosis and pathological staging to detailed evaluation of prognostic factors and molecular markers that optimize treatment, as well as evaluate treatment response. Currently, the AJCC TNM staging system is the most accepted staging system worldwide. It is necessary to adopt standard protocols for uniform staging and reporting of rectal cancer.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover 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

References

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

    Article  PubMed  Google Scholar 

  2. Fleshman JW. Multidisciplinary treatment of rectal cancer: the way of the future. JAMA Surg. 2013;148(8):778.

    Article  PubMed  Google Scholar 

  3. Evans J, Patel U, Brown G. Rectal cancer: primary staging and assessment after chemoradiotherapy. Semin Radiat Oncol. 2011;21(3):169–77.

    Article  PubMed  Google Scholar 

  4. Trakarnsanga A, Gonen M, Shia J, Goodman KA, Nash GM, Temple LK, et al. What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? Ann Surg Oncol. 2013;20(4):1179–84.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Benson 3rd AB, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, et al. Rectal cancer. J Natl Compr Canc Netw. 2012;10(12):1528–64.

    CAS  PubMed  Google Scholar 

  6. Morino M, Arezzo A, Allaix ME. Transanal endoscopic microsurgery. Tech Coloproctol. 2013;17 Suppl 1:S55–61.

    Article  PubMed  Google Scholar 

  7. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490–502.

    Google Scholar 

  8. van de Velde CJ, Boelens PG, Borras JM, Coebergh JW, Cervantes A, Blomqvist L, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50(1):1e–e34.

    Google Scholar 

  9. Parfitt JR, Driman DK. The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment. J Clin Pathol. 2007;60(8):849–55.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–34.

    Article  PubMed  Google Scholar 

  11. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009;133(10):1539–51.

    PubMed Central  PubMed  Google Scholar 

  12. van de Velde CJ, Boelens PG, Tanis PJ, Espin E, Mroczkowski P, Naredi P, et al. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: Science, opinions and experiences from the experts of surgery. Eur J Surg Oncol. 2014;40(4):454–68.

    Google Scholar 

  13. Quirke P, Palmer T, Hutchins GG, West NP. Histopathological work-up of resection specimens, local excisions and biopsies in colorectal cancer. Dig Dis. 2012;30 Suppl 2:2–8.

    Article  PubMed  Google Scholar 

  14. Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124(7):979–94.

    CAS  PubMed  Google Scholar 

  15. Yao YF, Wang L, Liu YQ, Li JY, 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(12):1073–7.

    Article  PubMed  Google Scholar 

  16. Pocard M, Panis Y, Malassagne B, Nemeth J, Hautefeuille P, Valleur P. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum. 1998;41(7):839–45.

    Article  CAS  PubMed  Google Scholar 

  17. Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson 3rd AB, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol. 2001;19(1):157–63.

    CAS  PubMed  Google Scholar 

  18. Kim YW, Kim NK, Min BS, Lee KY, Sohn SK, Cho CH. The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumor-specific mesorectal excision. Ann Surg. 2009;249(6):965–72.

    Article  PubMed  Google Scholar 

  19. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 6th ed. New York: Springer; 2010.

    Google Scholar 

  20. Desch CE, McNiff KK, Schneider EC, Schrag D, McClure J, Lepisto E, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol. 2008;26(21):3631–7.

    Article  PubMed  Google Scholar 

  21. Chapman B, Paquette C, Tooke C, Schwartz M, Osler T, Weaver D, et al. Impact of Schwartz enhanced visualization solution on staging colorectal cancer and clinicopathological features associated with lymph node count. Dis Colon Rectum. 2013;56(9):1028–35.

    Article  PubMed  Google Scholar 

  22. Jepsen RK, Ingeholm P, Lund EL. Upstaging of early colorectal cancers following improved lymph node yield after methylene blue injection. Histopathology. 2012;61(5):788–94.

    Article  PubMed  Google Scholar 

  23. Gehoff A, Basten O, Sprenger T, Conradi LC, Bismarck C, Bandorski D, et al. Optimal lymph node harvest in rectal cancer (UICC stages II and III) after preoperative 5-FU-based radiochemotherapy. Acetone compression is a new and highly efficient method. Am J Surg Pathol. 2012;36(2):202–13.

    Article  PubMed  Google Scholar 

  24. Quah HM, Chou JF, Gonen M, Shia J, Schrag D, Landmann RG, et al. Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum. 2008;51(5):503–7.

    Article  PubMed  Google Scholar 

  25. Damin DC, Rosito MA, Contu PC, Tarta C, Ferreira PR, Kliemann LM, et al. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg. 2012;16(8):1573–80.

    Article  PubMed  Google Scholar 

  26. Awwad GE, Tou SI, Rieger NA. Prognostic significance of lymph node yield after long-course preoperative radiotherapy in patients with rectal cancer: a systematic review. Colorectal Dis. 2013;15(4):394–403.

    Article  CAS  PubMed  Google Scholar 

  27. Ceelen W, Van Nieuwenhove Y, Pattyn P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol. 2010;17(11):2847–55.

    Article  CAS  PubMed  Google Scholar 

  28. Akagi Y, Adachi Y, Kinugasa T, Oka Y, Mizobe T, Shirouzu K. Lymph node evaluation and survival in colorectal cancer: review of population-based, prospective studies. Anticancer Res. 2013;33(7):2839–47.

    PubMed  Google Scholar 

  29. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumors of the digestive system. 4th ed. Lyon IARC; 2010.

    Google Scholar 

  30. Lee HJ, Eom DW, Kang GH, Han SH, Cheon GJ, Oh HS, et al. Colorectal micropapillary carcinomas are associated with poor prognosis and enriched in markers of stem cells. Mod Pathol. 2013;26(8):1123–31.

    Article  CAS  PubMed  Google Scholar 

  31. Laiho P, Kokko A, Vanharanta S, Salovaara R, Sammalkorpi H, Jarvinen H, et al. Serrated carcinomas form a subclass of colorectal cancer with distinct molecular basis. Oncogene. 2007;26(2):312–20.

    Article  CAS  PubMed  Google Scholar 

  32. Conesa-Zamora P, Garcia-Solano J, Garcia-Garcia F, Turpin MD, Trujillo-Santos J, Torres-Moreno D, et al. Expression profiling shows differential molecular pathways and provides potential new diagnostic biomarkers for colorectal serrated adenocarcinoma. Int J Cancer. 2013;132(2):297–307.

    Article  CAS  PubMed  Google Scholar 

  33. Chirieac LR, Shen L, Catalano PJ, Issa JP, Hamilton SR. Phenotype of microsatellite-stable colorectal carcinomas with CpG island methylation. Am J Surg Pathol. 2005;29(4):429–36.

    Article  PubMed  Google Scholar 

  34. Washington MK, Berlin J, Branton PA, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinomas of the colon and rectum. Arch Pathol Lab Med. 2008;132(7):1182–93.

    PubMed  Google Scholar 

  35. Ueno H, Kajiwara Y, Shimazaki H, Shinto E, Hashiguchi Y, Nakanishi K, et al. New criteria for histologic grading of colorectal cancer. Am J Surg Pathol. 2012;36(2):193–201.

    Article  PubMed  Google Scholar 

  36. Barresi V, Bonetti LR, Ieni A, Branca G, Baron L, Tuccari G. Histologic grading based on counting poorly differentiated clusters in preoperative biopsy predicts nodal involvement and pTNM stage in colorectal cancer patients. Hum Pathol. 2014;45(2):268–75.

    Article  PubMed  Google Scholar 

  37. Jass JR, Atkin WS, Cuzick J, Bussey HJ, Morson BC, Northover JM, et al. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology. 1986;10(5):437–59.

    Article  CAS  PubMed  Google Scholar 

  38. Wohlke M, Schiffmann L, Prall F. Aggressive colorectal carcinoma phenotypes of invasion can be assessed reproducibly and effectively predict poor survival: interobserver study and multivariate survival analysis of a prospectively collected series of 299 patients after potentially curative resections with long-term follow-up. Histopathology. 2011;59(5):857–66.

    Article  PubMed  Google Scholar 

  39. Akimoto N, Fujimori T, Mitomi H, Ichikawa K, Tomita S, Tatsuguchi A, et al. Micropapillary pattern at the invasive front and its association with unresectable colorectal carcinomas. Dis Markers. 2013;35(5):451–5.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Richards CH, Roxburgh CS, Powell AG, Foulis AK, Horgan PG, McMillan DC. The clinical utility of the local inflammatory response in colorectal cancer. Eur J Cancer. 2014;50(2):309–19.

    Article  CAS  PubMed  Google Scholar 

  41. Xu W, Liu H, Song J, Fu HX, Qiu L, Zhang BF, et al. The appearance of Tregs in cancer nest is a promising independent risk factor in colon cancer. J Cancer Res Clin Oncol. 2013;139(11):1845–52.

    Article  CAS  PubMed  Google Scholar 

  42. Graham DM, Appelman HD. Crohn’s-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator. Mod Pathol. 1990;3(3):332–5.

    CAS  PubMed  Google Scholar 

  43. Tougeron D, Fauquembergue E, Latouche JB. Immune response and colorectal cancer. Bull Cancer. 2013;100(3):283–94. Reponse immunitaire et cancers colorectaux.

    CAS  PubMed  Google Scholar 

  44. Phipps AI, Lindor NM, Jenkins MA, Baron JA, Win AK, Gallinger S, et al. Colon and rectal cancer survival by tumor location and microsatellite instability: the Colon Cancer Family Registry. Dis Colon Rectum. 2013;56(8):937–44.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Hartman DJ, Brand RE, Hu H, Bahary N, Dudley B, Chiosea SI, et al. Lynch syndrome-associated colorectal carcinoma: frequent involvement of the left colon and rectum and late-onset presentation supports a universal screening approach. Hum Pathol. 2013;44(11):2518–28.

    Article  PubMed  Google Scholar 

  46. Zhang X, Li J. Era of universal testing of microsatellite instability in colorectal cancer. World J Gastrointest Oncol. 2013;5(2):12–9.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Prall F. Tumour budding in colorectal carcinoma. Histopathology. 2007;50(1):151–62.

    Article  CAS  PubMed  Google Scholar 

  48. Masaki T, Matsuoka H, Sugiyama M, Abe N, Izumisato Y, Goto A, et al. Laminin-5 gamma 2 chain and matrix metalloproteinase-2 may trigger colorectal carcinoma invasiveness through formation of budding tumor cells. Anticancer Res. 2003;23(5b):4113–9.

    CAS  PubMed  Google Scholar 

  49. Yusra, Semba S, Yokozaki H. Biological significance of tumor budding at the invasive front of human colorectal carcinoma cells. Int J Oncol. 2012;41(1):201–10.

    CAS  PubMed  Google Scholar 

  50. Karamitopoulou E, Zlobec I, Kolzer V, Kondi-Pafiti A, Patsouris ES, Gennatas K, et al. Proposal for a 10-high-power-fields scoring method for the assessment of tumor budding in colorectal cancer. Mod Pathol. 2013;26(2):295–301.

    Article  CAS  PubMed  Google Scholar 

  51. Mitrovic B, Schaeffer DF, Riddell RH, Kirsch R. Tumor budding in colorectal carcinoma: time to take notice. Mod Pathol. 2012;25(10):1315–25.

    Article  CAS  PubMed  Google Scholar 

  52. Betge J, Kornprat P, Pollheimer MJ, Lindtner RA, Schlemmer A, Rehak P, et al. Tumor budding is an independent predictor of outcome in AJCC/UICC stage II colorectal cancer. Ann Surg Oncol. 2012;19(12):3706–12.

    Article  PubMed  Google Scholar 

  53. Cserni G, Sejben I, Bori R. Diagnosing vascular invasion in colorectal carcinomas: improving reproducibility and potential pitfalls. J Clin Pathol. 2013;66(7):543–7.

    Article  CAS  PubMed  Google Scholar 

  54. Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schlemmer A, Rehak P, et al. Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer. 2012;118(3):628–38.

    Article  PubMed  Google Scholar 

  55. Messenger DE, Driman DK, Kirsch R. Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol. 2012;43(7):965–73.

    Article  PubMed  Google Scholar 

  56. Mori D, Shibaki M, Masuda M, Yamasaki F. Quantitative measurement of venous invasion of colorectal cancer with metachronous liver metastasis. Histopathology. 2009;55(6):654–9.

    Article  PubMed  Google Scholar 

  57. White M, Foulis AK, Smith G, Horgan PG, Roxburgh CS. The role of S100 staining in the pathological assessment of perineural invasion in rectal cancer. Colorectal Dis. 2014;16(1):71–2.

    Article  CAS  PubMed  Google Scholar 

  58. Ueno H, Shirouzu K, Eishi Y, Yamada K, Kusumi T, Kushima R, et al. Characterization of perineural invasion as a component of colorectal cancer staging. Am J Surg Pathol. 2013;37(10):1542–9.

    Article  PubMed  Google Scholar 

  59. Wunsch K, Muller J, Jahnig H, Herrmann RA, Arnholdt HM, Markl B. Shape is not associated with the origin of pericolonic tumor deposits. Am J Clin Pathol. 2010;133(3):388–94. Epub 2010/02/16.

    Article  PubMed  Google Scholar 

  60. Puppa G, Maisonneuve P, Sonzogni A, Masullo M, Capelli P, Chilosi M, et al. Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging. Mod Pathol. 2007;20(8):843–55.

    Article  PubMed  Google Scholar 

  61. Ueno H, Mochizuki H, Shirouzu K, Kusumi T, Yamada K, Ikegami M, et al. Multicenter study for optimal categorization of extramural tumor deposits for colorectal cancer staging. Ann Surg. 2012;255(4):739–46. Epub 2012/03/08.

    Article  PubMed  Google Scholar 

  62. Nagtegaal ID, Quirke P, Schmoll HJ. Has the new TNM classification for colorectal cancer improved care? Nat Rev Clin Oncol. 2012;9(2):119–23.

    Article  Google Scholar 

  63. 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(5):671–9.

    Article  PubMed  Google Scholar 

  64. Shia J, Klimstra DS, Bagci P, Basturk O, Adsay NV. TNM staging of colorectal carcinoma: issues and caveats. Semin Diagn Pathol. 2012;29(3):142–53.

    Article  PubMed  Google Scholar 

  65. Liang WY, Chang WC, Hsu CY, Arnason T, Berger D, Hawkins AT, et al. Retrospective evaluation of elastic stain in the assessment of serosal invasion of pT3N0 colorectal cancers. Am J Surg Pathol. 2013;37(10):1565–70.

    Article  PubMed  Google Scholar 

  66. Kojima M, Nakajima K, Ishii G, Saito N, Ochiai A. Peritoneal elastic laminal invasion of colorectal cancer: the diagnostic utility and clinicopathologic relationship. Am J Surg Pathol. 2010;34(9):1351–60.

    Article  PubMed  Google Scholar 

  67. Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235(4):449–57.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Lin HH, Lin JK, Lin CC, Lan YT, Wang HS, Yang SH, et al. Circumferential margin plays an independent impact on the outcome of rectal cancer patients receiving curative total mesorectal excision. Am J Surg. 2013;206(5):771–7.

    Article  PubMed  Google Scholar 

  69. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002;45(2):200–6.

    Article  PubMed  Google Scholar 

  70. Shia J, Tickoo SK, Guillem JG, Qin J, Nissan A, Hoos A, et al. Increased endocrine cells in treated rectal adenocarcinomas: a possible reflection of endocrine differentiation in tumor cells induced by chemotherapy and radiotherapy. Am J Surg Pathol. 2002;26(7):863–72.

    Article  PubMed  Google Scholar 

  71. Shia J, McManus M, Guillem JG, Leibold T, Zhou Q, Tang LH, et al. Significance of acellular mucin pools in rectal carcinoma after neoadjuvant chemoradiotherapy. Am J Surg Pathol. 2011;35(1):127–34.

    Article  PubMed  Google Scholar 

  72. Dukes CE. The classification of cancer of the rectum. J Pathol Bacteriol. 1932;35(3):323–32.

    Article  Google Scholar 

  73. Kim CH, Huh JW. How could the TNM system be best adapted for staging rectal cancer in the future? Curr Colorectal Cancer Rep. 2013;9(2):130–5.

    Article  Google Scholar 

  74. Hashiguchi Y, Hase K, Kotake K, Ueno H, Shinto E, Mochizuki H, et al. Evaluation of the seventh edition of the tumour, node, metastasis (TNM) classification for colon cancer in two nationwide registries of the United States and Japan. Colorectal Dis. 2012;14(9):1065–74.

    Article  CAS  PubMed  Google Scholar 

  75. Fogt F, Zimmerman RL, Ross HM, Daly T, Gausas RE. Identification of lymphatic vessels in malignant, adenomatous and normal colonic mucosa using the novel immunostain D2-40. Oncol Rep. 2004;11(1):47–50.

    CAS  PubMed  Google Scholar 

  76. Shia J, Klimstra DS. Intramucosal poorly differentiated colorectal carcinoma: can it be managed conservatively? Am J Surg Pathol. 2008;32(10):1586–8; author reply 8–9.

    Article  PubMed  Google Scholar 

  77. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43.

    Article  PubMed  Google Scholar 

  78. Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38(12):1286–95.

    Article  CAS  PubMed  Google Scholar 

  79. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17(1):1–29.

    Article  PubMed  Google Scholar 

  80. Komori K, Hirai T, Kanemitsu Y, Shimizu Y, Sano T, Ito S, et al. Is “depth of submucosal invasion > or = 1,000 microm” an important predictive factor for lymph node metastases in early invasive colorectal cancer (pT1)? Hepatogastroenterology. 2010;57(102–103):1123–7.

    PubMed  Google Scholar 

  81. Rasheed S, Bowley DM, Aziz O, Tekkis PP, Sadat AE, Guenther T, et al. Can depth of tumour invasion predict lymph node positivity in patients undergoing resection for early rectal cancer? A comparative study between T1 and T2 cancers. Colorectal Dis. 2008;10(3):231–8.

    Article  CAS  PubMed  Google Scholar 

  82. Kobayashi H, Mochizuki H, Morita T, Kotake K, Teramoto T, Kameoka S, et al. Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study. J Gastroenterol. 2011;46(2):203–11.

    Article  PubMed  Google Scholar 

  83. Komori K, Kanemitsu Y, Ishiguro S, Shimizu Y, Sano T, Kato T. Analysis of lymph node metastatic pattern according to the depth of in-growth in the muscularis propria in T2 rectal cancer for lateral lymph node dissection. Dig Surg. 2011;28(5–6):352–9.

    Article  PubMed  Google Scholar 

  84. Tong LL, Gao P, Wang ZN, Yue ZY, Song YX, Sun Z, et al. Is pT2 subclassification feasible to predict patient outcome in colorectal cancer? Ann Surg Oncol. 2011;18(5):1389–96.

    Article  PubMed  Google Scholar 

  85. Pollheimer MJ, Kornprat P, Pollheimer VS, Lindtner RA, Schlemmer A, Rehak P, et al. Clinical significance of pT sub-classification in surgical pathology of colorectal cancer. Int J Colorectal Dis. 2010;25(2):187–96.

    Article  PubMed  Google Scholar 

  86. Shin R, Jeong SY, Yoo HY, Park KJ, Heo SC, Kang GH, et al. Depth of mesorectal extension has prognostic significance in patients with T3 rectal cancer. Dis Colon Rectum. 2012;55(12):1220–8.

    Article  PubMed  Google Scholar 

  87. Akagi Y, Shirouzu K, Fujita S, Ueno H, Takii Y, Komori K, et al. Predicting oncologic outcomes by stratifying mesorectal extension in patients with pT3 rectal cancer: a Japanese multi-institutional study. Int J Cancer. 2012;131(5):1220–7.

    Article  CAS  PubMed  Google Scholar 

  88. Bori R, Sejben I, Svebis M, Vajda K, Marko L, Pajkos G, et al. Heterogeneity of pT3 colorectal carcinomas according to the depth of invasion. Pathol Oncol Res. 2009;15(3):527–32.

    Article  CAS  PubMed  Google Scholar 

  89. Miyoshi M, Ueno H, Hashiguchi Y, Mochizuki H, Talbot IC. Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients. Ann Surg. 2006;243(4):492–8.

    Article  PubMed Central  PubMed  Google Scholar 

  90. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart A. Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol. 2010;28(2):256–63.

    Article  PubMed Central  PubMed  Google Scholar 

  91. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol. 2010;28(2):264–71.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Stewart CJ, Hillery S, Platell C, Puppa G. Assessment of serosal invasion and criteria for the classification of pathological (p) T4 staging in colorectal carcinoma: confusions, controversies and criticisms. Cancers (Basel). 2011;3(1):164–81.

    Article  Google Scholar 

  93. van der Pas MH, Meijer S, Hoekstra OS, Riphagen II, de Vet HC, Knol DL, et al. Sentinel-lymph-node procedure in colon and rectal cancer: a systematic review and meta-analysis. Lancet Oncol. 2011;12(6):540–50.

    Article  PubMed  Google Scholar 

  94. van der Zaag ES, Bouma WH, Peters HM, Bemelman WA, Buskens CJ. Implications of sentinel lymph node mapping on nodal staging and prognosis in colorectal cancer. Colorectal Dis. 2012;14(6):684–90.

    Article  PubMed  Google Scholar 

  95. Wiese D, Sirop S, Yestrepsky B, Ghanem M, Bassily N, Ng P, et al. Ultrastaging of sentinel lymph nodes (SLNs) vs. non-SLNs in colorectal cancer – do we need both? Am J Surg. 2010;199(3):354–8.

    Article  PubMed  Google Scholar 

  96. Bembenek A. Current clinical status of sentinel lymph nodes in colon and proximal rectal cancer. Colorectal Dis. 2011;13 Suppl 7:63–6.

    Article  PubMed  Google Scholar 

  97. Kim JW. The clinical usefulness of the sentinel lymph node in rectal cancer: do we believe it? J Korean Soc Coloproctol. 2011;27(2):51–2.

    Article  PubMed Central  PubMed  Google Scholar 

  98. Rahbari NN, Bork U, Motschall E, Thorlund K, Buchler MW, Koch M, et al. Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(1):60–70.

    Article  PubMed  Google Scholar 

  99. Allegra CJ, Jessup JM, Somerfield MR, Hamilton SR, Hammond EH, Hayes DF, et al. American Society of Clinical Oncology provisional clinical opinion: testing for KRAS gene mutations in patients with metastatic colorectal carcinoma to predict response to anti-epidermal growth factor receptor monoclonal antibody therapy. J Clin Oncol. 2009;27(12):2091–6.

    Article  PubMed  Google Scholar 

  100. De Roock W, De Vriendt V, Normanno N, Ciardiello F. KRAS, BRAF, PIK3CA, and PTEN mutations: implications for targeted therapies in metastatic colorectal cancer. Lancet Oncol. 2011;12(6):594–603.

    Article  PubMed  Google Scholar 

  101. Sood A, McClain D, Maitra R, Basu-Mallick A, Seetharam R, Kaubisch A, et al. PTEN gene expression and mutations in the PIK3CA gene as predictors of clinical benefit to anti-epidermal growth factor receptor antibody therapy in patients with KRAS wild-type metastatic colorectal cancer. Clin Colorectal Cancer. 2012;11(2):143–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  102. Bartley AN, Hamilton SR, Alsabeh R, Ambinder EP, Berman M, Collins E, et al. Template for reporting results of biomarker testing of specimens from patients with carcinoma of the colon and rectum. Arch Pathol Lab Med. 2014;138(2):166–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA

    Xuchen Zhang MD, PhD & Dhanpat Jain MD

Authors
  1. Xuchen Zhang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dhanpat Jain MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dhanpat Jain MD .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Walter E. Longo

  2. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Vikram Reddy

  3. University of Liverpool St Helens Teaching Hospital, St Helens, United Kingdom

    Riccardo A. Audisio

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Zhang, X., Jain, D. (2015). Pathology and Staging of Rectal Cancer. In: Longo, W., Reddy, V., Audisio, R. (eds) Modern Management of Cancer of the Rectum. Springer, London. https://doi.org/10.1007/978-1-4471-6609-2_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6609-2_4

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6608-5

  • Online ISBN: 978-1-4471-6609-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation