Staging of colorectal cancer

  • R. John Nicholls
  • Neil J. McC. Mortensen
  • John M. A. Northover
Conference paper

Abstract

Moderator: Dr. Jass. The staging of colorectal cancer, a seemingly innocuous and dry subject, has within the last few years become topical and indeed spiked with emotion. A panel of five surgeons and five histopathologists, all with a special interest in colorectal cancer, have been invited to respond to a series of pertinent but fairly open-ended questions. I hope that you will find their answers both thought-provoking and instructive.

Keywords

Formalin Europe Adenocarcinoma Adenoma Barium 

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References

  1. 1.
    Dukes CE (1932) The classification of cancer of the rectum. J Pathol Bacteriol 35: 323–332CrossRefGoogle Scholar
  2. 2.
    Turnbull RB, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technique on survival rates. Ann Surg 166: 420–427PubMedCrossRefGoogle Scholar
  3. 3.
    Newland RC, Chapuis PH, Pheils MT, Macpherson JG (1981) The relationship of survival to staging and grading of colorectal cancer: a prospective study of 503 cases. Cancer 47: 1424–1429PubMedCrossRefGoogle Scholar
  4. 4.
    Davis NC, Newland RC (1983) Terminology and classification of colorectal adenocarcinoma: The Australian Clinico-pathological Staging System. Aust NZ J Surg 53: 211–221Google Scholar
  5. 5.
    Goligher JC (1976) The Dukes’ A, B and C Categorisation of the extent of spread of carcinomas of the rectum. Surg Gynecol Obstet 143: 793–794PubMedGoogle Scholar
  6. 6.
    Chapuis PH, Fisher R, Dent OF. Newland RC, Pheils MT (1985) The relationship between different staging methods and survival in colorectal carcinoma. Dis Colon Rectum 28: 158–161PubMedCrossRefGoogle Scholar
  7. 7.
    Newland RC, Chapuis PH, Smyth EJ (1987) The prognostic value of substaging colorectal carcinoma: a prospective study of 1117 cases with standardised pathology. Cancer (in press)Google Scholar
  8. 8.
    Chapuis PH, Dent OF, Fisher R, Newland RC, Pheils MT, Smyth E, Colquhoun K (1985) A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg 72: 698–702PubMedCrossRefGoogle Scholar
  9. 9.
    Rubio CA, Emas S, Nylander G (1977) A critical reappraisal of Dukes’ classification. Surg Gynecol Obstet 145: 682–684PubMedGoogle Scholar
  10. 10.
    Smith DL, Signorino CE, De La Cruz TO, Lewis MI (1970) Staging of colonic and rectal carcinomas: a review of ten years’ experience at a Private Hospital. Dis Colon Rectum 13: 302–307PubMedCrossRefGoogle Scholar
  11. 11.
    Roseman DL, Strauss AK (1980) Staging of carcinoma of the colon and rectum. Surg Gynecol Obstet 151: 93–95PubMedGoogle Scholar
  12. 12.
    Karavias TL, Hirner A, Haring R (1980) Problems in classifying colorectal carcinomata–The Dukes-ABC-System. Coloproctology 2: 241–244Google Scholar
  13. 13.
    Fitzgerald RH (1982) What is the Dukes’ System for carcinoma of the rectum? Dis Colon Rectum 25: 474–477PubMedCrossRefGoogle Scholar
  14. 14.
    Zinkin LD (1983) A critical review of the classifications and staging of colorectal cancer. Dis Colon Rectum 26: 37–43PubMedCrossRefGoogle Scholar
  15. 15.
    Donegan WL, De Cosse JJ (1978) Pitfalls and controversies in the staging of colorectal carcinoma. In: Enker WE (ed) Carcinoma of the colon and rectum, Year Book Medical, Chicago London, pp 49–70Google Scholar
  16. 16.
    Kyriakos M (1985) The President’s cancer, the Dukes classification, and confusion. Arch Pathol Lab Med 109: 1963–1066Google Scholar
  17. 17.
    Marwick C (1986) Staging of President’s cancer continues to stimulate discussion. JAMA 255: 2533–2536PubMedCrossRefGoogle Scholar
  18. 18.
    Kirklin JW, Dockerty MB, Waugh JM (1949) The role of the peritoneal reflection in the prognosis of carcinoma of the rectum and sigmoid colon. Surg Gynecol Obstet 88: 326–331PubMedGoogle Scholar
  19. 19.
    Astler VB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139: 846–852PubMedCrossRefGoogle Scholar
  20. 20.
    Chapuis PH, Dent OF, Newland RC, Bokey EL, Pheils MT (1986) An evaluation of the American Joint Committee pTNM Staging method for cancer of the colon and rectum. Dis Colon Rectum 29: 6–10PubMedCrossRefGoogle Scholar
  21. 21.
    Dukes CE, Bussey HJR (1958) The spread of rectal cancer and its effect on prognosis. Br J Cancer 12: 309–320PubMedCrossRefGoogle Scholar
  22. 22.
    Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Lancet 2: 996–999PubMedCrossRefGoogle Scholar
  23. 23.
    Talbot IC, Ritchie S, Leighton MA, Hughes AO, Bussey HJR, Morson BC (1980) The clinical significance of invasion of veins by rectal cancer. Br J Surg 67: 439–442PubMedCrossRefGoogle Scholar
  24. 24.
    Russell AH, Pelton J, Reheis CE, Wisbeck WM, Tong DY, Dawson LE (1985) Adenocarcinoma of the colon: an autopsy study with implications for new therapeutic strategies. Cancer 56: 1446–1451PubMedCrossRefGoogle Scholar
  25. 25.
    Phillips RK, Hittinger R, Blesovsky L, Frye JS, Fielding LP (1984) Local recurrence following `curative’ surgery for large bowel cancer II. The rectum and rectosigmoid. Br J Surg 71: 17–20Google Scholar
  26. 26.
    Fielding LP, Phillips RKS, Frye JS, Hittinger R (1986) The prediction of outcome after curative resection for large bowel cancer. Lancet 2: 904–907PubMedCrossRefGoogle Scholar
  27. 27.
    Blenkinsopp WK, Stewart-Brown S, Blesovsky L, Kearney G, Fielding LP (1981) Histopathology reporting in large bowel cancer. J Clin Pathol 34: 598–613CrossRefGoogle Scholar
  28. 28.
    Nathanson SD, Schultz L, Tilley B, Kambouris A (1986) Carcinomas of the colon and rectum. A comparison of staging classifications. Am Surg 52: 429–433Google Scholar
  29. 29.
    Ham AW, Cormack DH (1979) Histology, 8th edn. JB Lippincott, PhiladelphiaGoogle Scholar
  30. 30.
    Hermanek P (1986) Problems of pTNM classification of carcinoma of the stomach, colorectum and anal margin. Pathol Res Pract 181: 296–300PubMedCrossRefGoogle Scholar
  31. 31.
    Perzin KH, Fenoglio CM, Pascal RR (1983) Neoplastic diseases of the small and large intestine. In: Siverberg SG (ed) Principles and practice of surgical pathology. John Wiley, New York, p 921Google Scholar
  32. 32.
    Cohn I Jr, Nance FC (1977) The colon and rectum. In: Sabiston DC Jr (ed) Davis-Christopher textbook of surgery, 11th edn. WB Saunders, Philadelphia, p 1108Google Scholar
  33. 33.
    American Joint Committee on Cancer (1983) Manual for staging of cancer. In: Beahrs OH, Myers MD (eds). JB Lippincott, Philadelphia, pp 73–80Google Scholar
  34. 34.
    Hutter RVP, Sobin LH (1986) A universal staging system for cancer of the colon and rectum. Let there be light. Arch Pathol Lab Med 110: 367–368Google Scholar
  35. 35.
    Thynne GS, Weiland LH, Moertel CG, Silvers A (1980) Correlation of histopathologic characteristics of primary tumour and uninvolved regional lymph nodes in Dukes’ class C colonic carcinoma with prognosis. Mayo Clin Proc 55: 243–245PubMedGoogle Scholar
  36. 36.
    Wolmark N, Fisher B, Wieand HS (1986) The prognostic value of the modifications of the Dukes’ C class of colorectal cancer. Ann Surg 203: 115–122PubMedCrossRefGoogle Scholar
  37. 37.
    Jass JR, Morson BC (1986) A universal staging system for cancer of the colon and rectum revisited. Arch Pathol Lab Med 110: 1119 (Letter)Google Scholar
  38. 38.
    Gastrointestinal Tumour Study Group (1984) Adjuvant therapy of colon cancer — results of a prospectively randomized trial. N Engl J Med 310: 737–743CrossRefGoogle Scholar
  39. 39.
    Jass JR, Atkin WS, Cuzick J, Bussey HJR, Morson BC, Northover JMA, Todd IP (1986) The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 10: 437–459PubMedCrossRefGoogle Scholar
  40. 40.
    Buckwalter JA, Thomas MS, Kent H (1973) Colonic cancer — essential information for a pathologic report. Arch Pathol 95: 366–370PubMedGoogle Scholar
  41. 41.
    Cawthorn SJ, Gibbs NM, Marks CG (1986) Clearance techniques for the detection of lymph nodes in colorectal cancer. Br J Surg 73: 58–60PubMedCrossRefGoogle Scholar
  42. 42.
    Jass JR, Miller K, Northover JMA (1986) Fat clearance method versus manual dissection of lymph nodes in specimens of rectal cancer. Int J Colorect Dis 1: 155–156CrossRefGoogle Scholar
  43. 43.
    Qizilbash A (1982) Pathologic studies in colorectal cancer. A guide to the surgical pathology examination of colorectal specimens and review of features of prognostic significance. PatholAnnu 17: 1–46PubMedGoogle Scholar
  44. 44.
    Morson BC (1981) Histopathology reporting in large-bowel cancer. Br Med J 283: 1493–1494CrossRefGoogle Scholar
  45. 45.
    Buckwalter JA Jr, Kent TH (1973) Prognosis and surgical pathology of carcinoma of the colon. Surg Gynaecol Obstet 136: 465–472Google Scholar
  46. 46.
    Thomas GDH, Dixon MF, Smeeton NC, Williams NS (1983) Observer variation in the histological grading of rectal carcinoma. J Clin Pathol 36: 385–391PubMedCrossRefGoogle Scholar
  47. 47.
    Quirke P, Durdey P, Dixon MF, Dyson JED, Williams NS, Bird CC (1987) The prognostic significance of DNA aneuploidy in rectal adenocarcinomas. J Pathol 151: 285–291PubMedCrossRefGoogle Scholar
  48. 48.
    Finan PJ, Quirke P, Dixon MF, Dyson JED, Giles GR, Bird CC (1986) Is DNA aneuploidy a good prognostic indicator in patients with advanced colorectal cancer? Br J Cancer 54: 327–330PubMedCrossRefGoogle Scholar
  49. 49.
    Chapuis PH, Newland RC, Payne JE, Macpherson JG, Pheils MT (1980) Preoperative carcinoembryonic antigen level and prognosis in colorectal cancer. Med J Aus 2: 140–143Google Scholar
  50. 50.
    Freedman LS, Macaskill P, Smith AN (1984) Multivariate analysis of prognostic factors for operable rectal cancer. Lancet 2: 733–736PubMedCrossRefGoogle Scholar
  51. 51.
    Williams NS, Durdey P, Quirke P, Robinson PJ, Dyson JED, Dixon MF, Bird CC (1985) Pre-operative staging of rectal neoplasm and its impact on clinical management. Br J Surg 72: 868–874PubMedCrossRefGoogle Scholar
  52. 52.
    Zorzitto M, Germanson T, Cummings B, Boyd NF (1982) A method of clinical prognostic staging for patients with rectal cancer. Dis Colon Rectum 25: 759–765PubMedCrossRefGoogle Scholar
  53. 53.
    Nicholls RJ, Mason AY, Morson BC (1982) The clinical staging of rectal cancer. Br J Surg 69: 404–409PubMedCrossRefGoogle Scholar
  54. 54.
    Finlay IG, McArdle CS (1986) Occult hepatic metastases in colorectal carcinoma. Br J Surg 73: 732–735PubMedCrossRefGoogle Scholar
  55. 55.
    Jass JR, Love SB, Northover JMA (1987) A new prognostic classification of rectal cancer. Lancet 1: 1303–1306PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • R. John Nicholls
    • 1
  • Neil J. McC. Mortensen
    • 2
  • John M. A. Northover
    • 1
  1. 1.St. Mark’s HospitalLondonUK
  2. 2.John Radcliffe HospitalHeadington, OxfordUK

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