48,706
edits
(37 intermediate revisions by 5 users not shown) | |||
Line 13: | Line 13: | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = [[lower anterior resection for cancer grossing]], other protocols | ||
| Staging = [[colorectal cancer staging]] | |||
| Site = [[rectum]], [[colon]], [[cecum]], [[appendix]] | | Site = [[rectum]], [[colon]], [[cecum]], [[appendix]] | ||
| Assdx = long standing IBD ([[Crohn's disease]], [[ulcerative colitis]]), [[traditional adenoma]] esp. with high-grade dysplasia, [[sessile serrated adenoma]] esp. with dysplasia | | Assdx = long standing IBD ([[Crohn's disease]], [[ulcerative colitis]]), [[traditional adenoma]] esp. with high-grade dysplasia, [[sessile serrated adenoma]] esp. with dysplasia | ||
Line 21: | Line 22: | ||
| Symptoms = +/-constipation | | Symptoms = +/-constipation | ||
| Prevalence = common | | Prevalence = common | ||
| Bloodwork = +/-[[anemia]] (microcytic) | | Bloodwork = +/-[[anemia]] (microcytic), +/-CEA elevated | ||
| Rads = +/-"apple core" lesion (classic), +/-findings of bowel obstruction (air-fluid levels esp. with transition point) | | Rads = +/-"apple core" lesion (classic), +/-findings of bowel obstruction (air-fluid levels esp. with transition point) | ||
| Endoscopy = +/-suspicious mass (exophytic or ulcerated), presence of non-lifting sign, [[Kudo pit pattern]] Type V<sub>I</sub> or Type V<sub>N</sub> | | Endoscopy = +/-suspicious mass (exophytic or ulcerated), presence of non-lifting sign, [[Kudo pit pattern]] Type V<sub>I</sub> or Type V<sub>N</sub> | ||
Line 27: | Line 28: | ||
| Other = fecal occult blood test (FOBT) +ve | | Other = fecal occult blood test (FOBT) +ve | ||
| ClinDDx = [[colorectal tumours]], other causes - DDx dependent on presentation | | ClinDDx = [[colorectal tumours]], other causes - DDx dependent on presentation | ||
| Tx = usually surgical resection +/-chemotherapy +/-radiation | |||
}} | }} | ||
'''Colorectal adenocarcinoma''' is very common, | '''Colorectal adenocarcinoma''' is very common, a leading cause of death due to [[cancer]], and the most common form of colon cancer. | ||
The [[colon]] and [[rectum]] are lumped together as the mucosa in the large bowel is very similar. Thus, '''colonic adenocarcinoma''' and '''rectal adenocarcinoma''' redirect to this article. | The [[colon]] and [[rectum]] are lumped together as the mucosa in the large bowel is very similar. Thus, '''colonic adenocarcinoma''' and '''rectal adenocarcinoma''' redirect to this article. | ||
Line 34: | Line 36: | ||
The larger generally topic of [[colorectal tumours]] and the pathogenesis of colorectal adenocarcinoma is dealt with in the [[colorectal tumours]] article. | The larger generally topic of [[colorectal tumours]] and the pathogenesis of colorectal adenocarcinoma is dealt with in the [[colorectal tumours]] article. | ||
'''Colorectal carcinoma''', abbreviated '''CRC''', is typically considered a synonym. | '''Colorectal carcinoma''', abbreviated '''CRC''', is typically considered a synonym. '''Cecal adenocarcinoma''' is also lumped into CRC. | ||
==General== | ==General== | ||
Line 41: | Line 43: | ||
Presentation: | Presentation: | ||
*Bright red blood per rectum (BRBPR). | *[[Bright red blood per rectum]] (BRBPR). | ||
*Constipation. | *Constipation. | ||
*Symptoms of bowel obstruction - nausea, vomiting. | *Symptoms of bowel obstruction - nausea, vomiting. | ||
*Weight loss. | |||
Pathogenesis - see ''[[Colorectal_tumours#Pathogenesis_of_colorectal_carcinoma|pathogenesis of colorectal carcinoma]]''. | Pathogenesis - see ''[[Colorectal_tumours#Pathogenesis_of_colorectal_carcinoma|pathogenesis of colorectal carcinoma]]''. | ||
Clinical - serum: | |||
*CEA elevated.<ref name=pmid24379990>{{Cite journal | last1 = Bagaria | first1 = B. | last2 = Sood | first2 = S. | last3 = Sharma | first3 = R. | last4 = Lalwani | first4 = S. | title = Comparative study of CEA and CA19-9 in esophageal, gastric and colon cancers individually and in combination (ROC curve analysis). | journal = Cancer Biol Med | volume = 10 | issue = 3 | pages = 148-57 | month = Sep | year = 2013 | doi = 10.7497/j.issn.2095-3941.2013.03.005 | PMID = 24379990 }}</ref> | |||
*CA19-9 elevated. | |||
*Colon cancer-specific antigen-2 (CCSA-2) elevated.<ref name=pmid24710115>{{Cite journal | last1 = Xue | first1 = G. | last2 = Wang | first2 = X. | last3 = Yang | first3 = Y. | last4 = Liu | first4 = D. | last5 = Cheng | first5 = Y. | last6 = Zhou | first6 = J. | last7 = Cao | first7 = Y. | title = Colon cancer-specific antigen-2 may be used as a detecting and prognostic marker in colorectal cancer: a preliminary observation. | journal = PLoS One | volume = 9 | issue = 4 | pages = e94252 | month = | year = 2014 | doi = 10.1371/journal.pone.0094252 | PMID = 24710115 }}</ref> | |||
**Relatively new; ''preliminary'' in 2014. | |||
==Gross== | ==Gross== | ||
Line 81: | Line 90: | ||
**Glands. | **Glands. | ||
**Sheets. | **Sheets. | ||
DDx: | |||
*Other [[adenocarcinoma]]s (e.g. [[anal gland adenocarcinoma]], [[lung adenocarcinoma]], [[ovarian adenocarcinoma]], [[ductal adenocarcinoma of the prostate]]). | |||
*[[Traditional adenoma]] esp. with high-grade dysplasia. | |||
*[[Sessile serrated adenoma]] with dysplasia. | |||
===Images=== | ===Images=== | ||
Line 102: | Line 116: | ||
Image:Crc_met_to_node1.jpg | CRC [[lymph node metastasis]]. (WC/Nephron) | Image:Crc_met_to_node1.jpg | CRC [[lymph node metastasis]]. (WC/Nephron) | ||
</gallery> | </gallery> | ||
<gallery> | |||
File:3 13657755265018 sl 1.png|Medullary carcinoma of cecum. | |||
File:3 13657755265018 sl 2.png|Medullary carcinoma of cecum. | |||
File:3 13657755265018 sl 3.png|Medullary carcinoma of cecum. | |||
File:3 13657755265018 sl 4.png|Medullary carcinoma of cecum. | |||
</gallery> | |||
Medullary carcinoma of cecum of elderly woman. A. Tumor extends from the luminal surface at upper left into the muscularis propria at lower right. Note variable longitudinal spaces in the tumor. B. Tumor extends into pericolic fat. Note relative circumscription, with pushing borders. C. Tumor cells, often in seeming syncitiums, strew lymphocytes. D. In other areas, there appears to be a pattern suggesting nests and stromal trabeculums. Chromogranin/synaptophysin were negative. | |||
www: | www: | ||
*[http://www.flickr.com/photos/euthman/2480926690/in/set-72057594114099781 Colorectal adenocarcinoma (flickr.com/euthman)]. | *[http://www.flickr.com/photos/euthman/2480926690/in/set-72057594114099781 Colorectal adenocarcinoma (flickr.com/euthman)]. | ||
===Grading=== | ===Grading=== | ||
8th edition of AJCC - based on component composed of glands: | |||
*Grade 1: >95% of tumour = ''well-differentiated''. | |||
*Grade 2: >=50-95% of tumour = ''moderately differentiated''. | |||
*Grade 3: <50% of tumour = ''poorly-differentiated''. | |||
*Grade 4: 0% glandular, no mucin, no squamous differentiation = ''undifferentiated''. | |||
====Old system==== | |||
Based on component composed of glands: | Based on component composed of glands: | ||
*>=50% of tumour = low-grade (''well-differentiated'' and ''moderately differentiated''). | *>=50% of tumour = low-grade (''well-differentiated'' and ''moderately differentiated''). | ||
*<50% of tumour = high-grade (''poorly-differentiated'' and ''undifferentiated''). | *<50% of tumour = high-grade (''poorly-differentiated'' and ''undifferentiated''). | ||
=== | ===Peritumoural lymphocytic response=== | ||
*[[AKA]] ''Crohn's-like lymphoid reaction''. | *[[AKA]] ''Crohn's-like lymphoid reaction''. | ||
*[[AKA]] ''Crohn's like reaction''.<ref name=pmid19825961>{{Cite journal | last1 = Ogino | first1 = S. | last2 = Nosho | first2 = K. | last3 = Irahara | first3 = N. | last4 = Meyerhardt | first4 = JA. | last5 = Baba | first5 = Y. | last6 = Shima | first6 = K. | last7 = Glickman | first7 = JN. | last8 = Ferrone | first8 = CR. | last9 = Mino-Kenudson | first9 = M. | title = Lymphocytic reaction to colorectal cancer is associated with longer survival, independent of lymph node count, microsatellite instability, and CpG island methylator phenotype. | journal = Clin Cancer Res | volume = 15 | issue = 20 | pages = 6412-20 | month = Oct | year = 2009 | doi = 10.1158/1078-0432.CCR-09-1438 | PMID = 19825961 }}</ref> | *[[AKA]] ''Crohn's like reaction''.<ref name=pmid19825961>{{Cite journal | last1 = Ogino | first1 = S. | last2 = Nosho | first2 = K. | last3 = Irahara | first3 = N. | last4 = Meyerhardt | first4 = JA. | last5 = Baba | first5 = Y. | last6 = Shima | first6 = K. | last7 = Glickman | first7 = JN. | last8 = Ferrone | first8 = CR. | last9 = Mino-Kenudson | first9 = M. | title = Lymphocytic reaction to colorectal cancer is associated with longer survival, independent of lymph node count, microsatellite instability, and CpG island methylator phenotype. | journal = Clin Cancer Res | volume = 15 | issue = 20 | pages = 6412-20 | month = Oct | year = 2009 | doi = 10.1158/1078-0432.CCR-09-1438 | PMID = 19825961 }}</ref> | ||
*[[AKA]] ''Crohn-like | *[[AKA]] ''Crohn-like response''.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/Colon_12protocol_3200.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/Colon_12protocol_3200.pdf]. Accessed on: 14 September 2012.</ref> | ||
{{Main|Peritumoural lymphocytic response}} | |||
===Intratumoural lymphocytic response=== | ===Intratumoural lymphocytic response=== | ||
*[[AKA]] '' tumour-infiltrating lymphocytes'', abbreviated ''TILs''. | *[[AKA]] '' tumour-infiltrating lymphocytes'', abbreviated ''TILs''. | ||
{{Main|Intratumoural lymphocytic response in colorectal carcinoma}} | |||
===Tumour deposits=== | ===Tumour deposits=== | ||
*[[AKA]] ''discoutinuous extramural extension''. | *[[AKA]] ''discoutinuous extramural extension''. | ||
*[[AKA]] ''peritumoral deposits''. | *[[AKA]] ''peritumoral deposits''. | ||
{{Main|Tumour deposit}} | |||
===Tumour regression=== | ===Tumour regression=== | ||
Line 223: | Line 171: | ||
==IHC== | ==IHC== | ||
*CK7 -ve. | *CK7 -ve. ‡ | ||
*CK20 +ve. | *CK20 +ve. | ||
*CEA +ve. | *CEA +ve. | ||
*CDX2 +ve. | *CDX2 +ve. | ||
Note: | |||
* ‡ High stage colorectal cancer (CRC) may be CK7 +ve/CK20 +ve; in one series, 13% of stage 3 and 17% of stage 4 colorectal cancers were CK7 +ve/CK20 +ve.<ref name=pmid15791572>{{Cite journal | last1 = Hernandez | first1 = BY. | last2 = Frierson | first2 = HF. | last3 = Moskaluk | first3 = CA. | last4 = Li | first4 = YJ. | last5 = Clegg | first5 = L. | last6 = Cote | first6 = TR. | last7 = McCusker | first7 = ME. | last8 = Hankey | first8 = BF. | last9 = Edwards | first9 = BK. | title = CK20 and CK7 protein expression in colorectal cancer: demonstration of the utility of a population-based tissue microarray. | journal = Hum Pathol | volume = 36 | issue = 3 | pages = 275-81 | month = Mar | year = 2005 | doi = 10.1016/j.humpath.2005.01.013 | PMID = 15791572 }}</ref> | |||
==Molecular== | ==Molecular== | ||
*KRAS mutation analysis. | *[[KRAS mutation]] analysis. | ||
**Mutation present ~ 40% of [[CRC]]. | **Mutation present ~ 40% of [[CRC]]. | ||
**Mutations in codons 12 or 13 associated with failure of [[EGFR inhibitors|anti-EGFR therapy]] (e.g. ''cetuximab'', ''panitumumab'').<ref name=pmid19792050>{{Cite journal | last1 = Monzon | first1 = FA. | last2 = Ogino | first2 = S. | last3 = Hammond | first3 = ME. | last4 = Halling | first4 = KC. | last5 = Bloom | first5 = KJ. | last6 = Nikiforova | first6 = MN. | title = The role of KRAS mutation testing in the management of patients with metastatic colorectal cancer. | journal = Arch Pathol Lab Med | volume = 133 | issue = 10 | pages = 1600-6 | month = Oct | year = 2009 | doi = 10.1043/1543-2165-133.10.1600 | PMID = 19792050 }}</ref> | **Mutations in codons 12 or 13 associated with failure of [[EGFR inhibitors|anti-EGFR therapy]] (e.g. ''cetuximab'', ''panitumumab'').<ref name=pmid19792050>{{Cite journal | last1 = Monzon | first1 = FA. | last2 = Ogino | first2 = S. | last3 = Hammond | first3 = ME. | last4 = Halling | first4 = KC. | last5 = Bloom | first5 = KJ. | last6 = Nikiforova | first6 = MN. | title = The role of KRAS mutation testing in the management of patients with metastatic colorectal cancer. | journal = Arch Pathol Lab Med | volume = 133 | issue = 10 | pages = 1600-6 | month = Oct | year = 2009 | doi = 10.1043/1543-2165-133.10.1600 | PMID = 19792050 }}</ref> | ||
*BRAF mutation analysis. | *BRAF mutation analysis. | ||
**''V600E'' missense mutation found in ~10% CRC.<ref name=pmid20635392>{{cite journal |author=Tie J, Gibbs P, Lipton L, ''et al.'' |title=Optimizing targeted therapeutic development: Analysis of a colorectal cancer patient population with the BRAF(V600E) mutation |journal=Int J Cancer |volume= |issue= |pages= |year=2010 |month=July |pmid=20635392 |doi=10.1002/ijc.25555 |url=}}</ref> | **''V600E'' missense mutation found in ~10% CRC.<ref name=pmid20635392>{{cite journal |author=Tie J, Gibbs P, Lipton L, ''et al.'' |title=Optimizing targeted therapeutic development: Analysis of a colorectal cancer patient population with the BRAF(V600E) mutation |journal=Int J Cancer |volume= |issue= |pages= |year=2010 |month=July |pmid=20635392 |doi=10.1002/ijc.25555 |url=}}</ref> | ||
*Microsatellite instability - see ''[[microsatellite instability in colorectal cancer]]''. | |||
Note: | Note: | ||
Line 259: | Line 211: | ||
- APPENDIX WITHOUT SIGNIFICANT PATHOLOGY. | - APPENDIX WITHOUT SIGNIFICANT PATHOLOGY. | ||
- FOURTEEN LYMPH NODES NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 14 ). | - FOURTEEN LYMPH NODES NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 14 ). | ||
</pre> | |||
===Left hemicolectomy=== | |||
<pre> | |||
LEFT COLON, LEFT HEMICOLECTOMY: | |||
- INVASIVE ADENOCARCINOMA, LOW-GRADE, pT1, pN0. | |||
-- MARGINS NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
-- TWELVE LYMPH NODES NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 12 ). | |||
-- PLEASE SEE TUMOUR SUMMARY. | |||
</pre> | |||
===Biomarker and molecular testing=== | |||
<pre> | |||
The Colorectal Cancer Panel (BRAF, KRAS, NRAS, PIK3CA, PTEN) was ordered on block {}. MMR testing was ordered on block {}. | |||
</pre> | </pre> | ||
edits