View source for Tumour perforation in colorectal cancer

'''Tumour perforation in colorectal cancer''' is the conjunction of an intestinal perforation and a [[colorectal tumour]].  

The Royal College of Pathologists Australia (RCPA) defines it as: perforation at the site of the tumour.<ref>URL: [https://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Specimen/Gastrointestinal/Colorectal/Colorectal-tumour https://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Specimen/Gastrointestinal/Colorectal/Colorectal-tumour]. Accessed on: June 21, 2018.</ref>

==Definitions==
*The Royal College of Pathologists Australia (RCPA) defines tumour perforation as: perforation at the site of the tumour.<ref>URL: [https://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Specimen/Gastrointestinal/Colorectal/Colorectal-tumour https://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Specimen/Gastrointestinal/Colorectal/Colorectal-tumour]. Accessed on: June 21, 2018.</ref>
*The College of American Pathologists protocol (version 4.3.1.0) cites Anwar ''et al.''<ref name=pmid17049848/> and notes that: perforation proximal to the tumour is a poor prognosticator.
**Possible implication: perforation at the tumour and proximal to the tumour may not be that different. 
*Banaszkiewicz ''et al.'' states that: the perforation site does ''not'' need to be at the anatomical site of the tumour.<ref name=pmid25784840>{{Cite journal  | last1 = Banaszkiewicz | first1 = Z. | last2 = Woda | first2 = Ł. | last3 = Tojek | first3 = K. | last4 = Jarmocik | first4 = P. | last5 = Jawień | first5 = A. | title = Colorectal cancer with intestinal perforation - a retrospective analysis of treatment outcomes. | journal = Contemp Oncol (Pozn) | volume = 18 | issue = 6 | pages = 414-8 | month =  | year = 2014 | doi = 10.5114/wo.2014.46362 | PMID = 25784840 }}</ref>

==General==
*Poor prognosticator.<ref name=pmid17049848>{{Cite journal  | last1 = Anwar | first1 = MA. | last2 = D'Souza | first2 = F. | last3 = Coulter | first3 = R. | last4 = Memon | first4 = B. | last5 = Khan | first5 = IM. | last6 = Memon | first6 = MA. | title = Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. | journal = Surg Oncol | volume = 15 | issue = 2 | pages = 91-6 | month = Aug | year = 2006 | doi = 10.1016/j.suronc.2006.09.001 | PMID = 17049848 }}</ref> 
*Does ''not'' affect the (overall) [[colorectal cancer staging|stage]]; however, it been suggested that perforated colorectal carcinoma be considered stage IV.<ref name=pmid19443386>{{Cite journal  | last1 = Ogawa | first1 = M. | last2 = Watanabe | first2 = M. | last3 = Eto | first3 = K. | last4 = Omachi | first4 = T. | last5 = Kosuge | first5 = M. | last6 = Hanyu | first6 = K. | last7 = Noaki | first7 = L. | last8 = Fujita | first8 = T. | last9 = Yanaga | first9 = K. | title = Clinicopathological features of perforated colorectal cancer. | journal = Anticancer Res | volume = 29 | issue = 5 | pages = 1681-4 | month = May | year = 2009 | doi =  | PMID = 19443386 }}</ref>

==Gross==
*Rim of defect should be inked at the time of gross.
*Ideally, a photograph should be taken.

==Microsopic==
Features:{{fact}}
*Inflammation on the external aspect (serosa).

DDx:
*Iatrogenic perforation - site of perforation has cautery.
*Artifact of extraction/handling ("tissue abuse").
**Artifact of extraction/handling is likely if all the following apply: (i) no inflammatory reaction is present, (ii) no cautery, and (iii) no perforation described in the operative report.

==See also==
*[[Colorectal cancer staging]].

==References==
{{Reflist|1}}

[[Category:Gastrointestinal pathology]]