Difference between revisions of "Tumour perforation in colorectal cancer"

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*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>  
*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>
*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==
*Defect should be inked at the time of gross.
*Ideally, a photograph should be taken.


==Microsopic==
==Microsopic==
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*Inflammation on the external aspect (serosa).
*Inflammation on the external aspect (serosa).


Note:
DDx:
*A colorectal wall defect may be an artifact of extraction ("tissue abuse") rather than perforation.
*Iatrogenic perforation - site of perforation has cautery.
*Artifact of extraction ("tissue abuse").
**Artifact of extraction 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.
**Artifact of extraction 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.


Revision as of 15:35, 27 August 2024

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.[1]

Definitions

  • The Royal College of Pathologists Australia (RCPA) defines tumour perforation as: perforation at the site of the tumour.[2]
  • The College of American Pathologists protocol (version 4.3.1.0) cites Anwar et al.[3] 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.[4]

General

  • Poor prognosticator.[3]
  • Does not affect the (overall) stage; however, it been suggested that perforated colorectal carcinoma be considered stage IV.[5]

Gross

  • Defect should be inked at the time of gross.
  • Ideally, a photograph should be taken.

Microsopic

Features:[citation needed]

  • Inflammation on the external aspect (serosa).

DDx:

  • Iatrogenic perforation - site of perforation has cautery.
  • Artifact of extraction ("tissue abuse").
    • Artifact of extraction 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

References

  1. ↑ URL: https://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Specimen/Gastrointestinal/Colorectal/Colorectal-tumour. Accessed on: June 21, 2018.
  2. ↑ URL: https://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Specimen/Gastrointestinal/Colorectal/Colorectal-tumour. Accessed on: June 21, 2018.
  3. ↑ 3.0 3.1 Anwar, MA.; D'Souza, F.; Coulter, R.; Memon, B.; Khan, IM.; Memon, MA. (Aug 2006). "Outcome of acutely perforated colorectal cancers: experience of a single district general hospital.". Surg Oncol 15 (2): 91-6. doi:10.1016/j.suronc.2006.09.001. PMID 17049848.
  4. ↑ Banaszkiewicz, Z.; Woda, Ł.; Tojek, K.; Jarmocik, P.; Jawień, A. (2014). "Colorectal cancer with intestinal perforation - a retrospective analysis of treatment outcomes.". Contemp Oncol (Pozn) 18 (6): 414-8. doi:10.5114/wo.2014.46362. PMID 25784840.
  5. ↑ Ogawa, M.; Watanabe, M.; Eto, K.; Omachi, T.; Kosuge, M.; Hanyu, K.; Noaki, L.; Fujita, T. et al. (May 2009). "Clinicopathological features of perforated colorectal cancer.". Anticancer Res 29 (5): 1681-4. PMID 19443386.
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