Difference between revisions of "Colorectal adenocarcinoma"

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Colorectal adenocarcinoma (view source)

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| 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
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| 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>
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| 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
| Tx        = usually surgical resection +/-chemotherapy +/-radiation
}}
}}
'''Colorectal adenocarcinoma''' is very common, and a leading cause of death due to [[cancer]].  
'''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.
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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. '''Cecal adenocarcinoma''' also lumped into CRC.
'''Colorectal carcinoma''', abbreviated '''CRC''', is typically considered a synonym. '''Cecal adenocarcinoma''' is also lumped into CRC.


==General==
==General==
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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==
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**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===
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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'').


===Peritumour lymphocytic response===
===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 repsonse''.<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>
*[[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}}
====General====
*Finding associated with improved survival in CRC.<ref name=pmid7821914 >{{Cite journal  | last1 = Harrison | first1 = JC. | last2 = Dean | first2 = PJ. | last3 = el-Zeky | first3 = F. | last4 = Vander Zwaag | first4 = R. | title = Impact of the Crohn's-like lymphoid reaction on staging of right-sided colon cancer: results of multivariate analysis. | journal = Hum Pathol | volume = 26 | issue = 1 | pages = 31-8 | month = Jan | year = 1995 | doi =  | PMID = 7821914 }}</ref>
 
====Microscopic====
[[Onlinepathology]] advocates use of the Ueno criteria. They have a better inter-rater reproducibility than the older Graham criteria<ref name=pmid2362940/> and are less complicated.
 
=====Ueno criteria (2013)=====
Required criteria:<ref name=pmid23525613>{{Cite journal  | last1 = Ueno | first1 = H. | last2 = Hashiguchi | first2 = Y. | last3 = Shimazaki | first3 = H. | last4 = Shinto | first4 = E. | last5 = Kajiwara | first5 = Y. | last6 = Nakanishi | first6 = K. | last7 = Kato | first7 = K. | last8 = Maekawa | first8 = K. | last9 = Miyai | first9 = K. | title = Objective Criteria for Crohn-like Lymphoid Reaction in Colorectal Cancer. | journal = Am J Clin Pathol | volume = 139 | issue = 4 | pages = 434-41 | month = Apr | year = 2013 | doi = 10.1309/AJCPWHUEFTGBWKE4 | PMID = 23525613 }}</ref>
*Non-MALT lymphoid aggregates (peritumoural) >= 1 mm.
 
Ignore:
#Muscosa-associated lymphoid tissue (MALT) = mucosal lymphoid aggregates, submucosal lymphoid aggregates adjacent to the musuclaris mucosae.
#Lymph nodes - these have a (fibrous) capsule.
#Irregular shape (not round).
 
=====Graham criteria (1990)=====
Required criteria:<ref name=pmid2362940>{{Cite journal  | last1 = Graham | first1 = DM. | last2 = Appelman | first2 = HD. | title = Crohn's-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator. | journal = Mod Pathol | volume = 3 | issue = 3 | pages = 332-5 | month = May | year = 1990 | doi =  | PMID = 2362940 }}</ref>
*Peritumoral:
*#Lymphoid aggregates with germinal centres focally.
*#Stellate fibrosis.
*#No previous clinical and pathologic evidence of [[Crohn's disease]].
 
Note:
*Should '''not''' be confused with [[intratumoural lymphocytic response]].
**The intratumoural lymphocytic response is associated with MSI-H cancers.
 
=====Images=====
<gallery>
Image:Peritumour lymphocytic response - low mag.jpg | PLR - low mag. (WC)
Image:Peritumour lymphocytic response - intermed mag.jpg | PLR - intermed. mag. (WC)
</gallery>
www:
*[http://jcp.bmjjournals.com/content/62/8/679/F2.large.jpg Peritumour lymphocytic response in endometrial carcinoma (bmjjournals.com)].
*[http://ajcp.ascpjournals.org/content/134/3/478/F3.expansion.html Peritumour lymphocytic response in CRC (ascpjournals.org)].<ref name=pmid20716806>{{Cite journal  | last1 = Ross | first1 = JS. | last2 = Torres-Mora | first2 = J. | last3 = Wagle | first3 = N. | last4 = Jennings | first4 = TA. | last5 = Jones | first5 = DM. | title = Biomarker-based prediction of response to therapy for colorectal cancer: current perspective. | journal = Am J Clin Pathol | volume = 134 | issue = 3 | pages = 478-90 | month = Sep | year = 2010 | doi = 10.1309/AJCP2Y8KTDPOAORH | PMID = 20716806 | URL = http://ajcp.ascpjournals.org/content/134/3/478.full}}</ref>


===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}}
====General====
*Finding is suggestive of microsatellite instabillity.<ref name=pmid21114775>{{Cite journal  | last1 = Iacopetta | first1 = B. | last2 = Grieu | first2 = F. | last3 = Amanuel | first3 = B. | title = Microsatellite instability in colorectal cancer. | journal = Asia Pac J Clin Oncol | volume = 6 | issue = 4 | pages = 260-9 | month = Dec | year = 2010 | doi = 10.1111/j.1743-7563.2010.01335.x | PMID = 21114775 }}</ref>
**May be seen in the context of [[Lynch syndrome]].
 
====Microscopic====
Features:
*Lymphocytes are between the tumour cells.<ref name=pmid19638537/> †
**Other lymphocytes do not count.
 
Note:
* † Definitions vary substantially - some authors consider lymphocytes adjacent to the tumour (in the stroma around the tumour cells) "intratumoural".<reF name=pmid9349235>{{Cite journal  | last1 = Ropponen | first1 = KM. | last2 = Eskelinen | first2 = MJ. | last3 = Lipponen | first3 = PK. | last4 = Alhava | first4 = E. | last5 = Kosma | first5 = VM. | title = Prognostic value of tumour-infiltrating lymphocytes (TILs) in colorectal cancer. | journal = J Pathol | volume = 182 | issue = 3 | pages = 318-24 | month = Jul | year = 1997 | doi = 10.1002/(SICI)1096-9896(199707)182:3318::AID-PATH8623.0.CO;2-6 | PMID = 9349235 |URL = http://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291096-9896%28199707%29182:3%3C318::AID-PATH862%3E3.0.CO;2-6/pdf}}</ref>
 
=====Images=====
<gallery>
Image: Tumour-infiltrating lymphocytes - 1 -- high mag.jpg | TILs - high mag. (WC)
Image: Tumour-infiltrating lymphocytes - 1 -- very high mag.jpg | TILS - very high mag. (WC)
Image: Tumour-infiltrating lymphocytes - 2 -- high mag.jpg | TILs - high mag.
Image: Tumour-infiltrating lymphocytes - 2 -- very high mag.jpg | TILs - very high mag.
Image: Tumour-infiltrating lymphocytes - 2 -- extremely high mag.jpg | TILs - extremely high mag.
</gallery>
www:
*[http://jcp.bmjjournals.com/content/62/8/679/F3.large.jpg TILs in endometrial carcinoma (bmjjournals.com)].<ref name=pmid19638537>{{Cite journal  | last1 = Garg | first1 = K. | last2 = Soslow | first2 = RA. | title = Lynch syndrome (hereditary non-polyposis colorectal cancer) and endometrial carcinoma. | journal = J Clin Pathol | volume = 62 | issue = 8 | pages = 679-84 | month = Aug | year = 2009 | doi = 10.1136/jcp.2009.064949 | PMID = 19638537 | URL = http://jcp.bmjjournals.com/content/62/8/679.full?related-urls=yes&legid=jclinpath;62/8/679 }}</ref>
*[http://ajcp.ascpjournals.org/content/134/3/478/F2.expansion.html TILs in CRC (ascpjournals.org)].<ref name=pmid20716806/>


===Tumour deposits===
===Tumour deposits===
*[[AKA]] ''discoutinuous extramural extension''.
*[[AKA]] ''discoutinuous extramural extension''.
*[[AKA]] ''peritumoral deposits''.
*[[AKA]] ''peritumoral deposits''.
====General====
{{Main|Tumour deposit}}
Definition - TNM/AJCC 7th edition:<ref name=pmid21555695/>
*Microscopic or macroscopic nodule in the lymphatic drainage bed of the tumour.
**No standardized distance (from tumour) criteria are defined.<ref name=pmid24112678>{{Cite journal  | last1 = Ueno | first1 = H. | last2 = Hashiguchi | first2 = Y. | last3 = Shimazaki | first3 = H. | last4 = Shinto | first4 = E. | last5 = Kajiwara | first5 = Y. | last6 = Nakanishi | first6 = K. | last7 = Kato | first7 = K. | last8 = Maekawa | first8 = K. | last9 = Nakamura | first9 = T. | title = Peritumoral deposits as an adverse prognostic indicator of colorectal cancer. | journal = Am J Surg | volume =  | issue =  | pages =  | month = Oct | year = 2013 | doi = 10.1016/j.amjsurg.2013.04.009 | PMID = 24112678 }}</ref>
*No findings suggestive of it being a lymph node replaced by tumour:
*#No significant lymphoid tissue.
*#Irregular contour.
*#*Round nodules of tumour are considered lymph nodes that are replaced by tumour.
 
Significance:
*Poor prognosticator.
**Can be understood as a type of invasive front/border, e.g. ''well-circumscribed border'' versus ''infiltrative border''.<ref name=pmid24112678/>
 
Staging implications:
*Tumour deposits are '''not''' counted as (positive) lymph nodes<ref name=pmid21555695>{{Cite journal  | last1 = Nagtegaal | first1 = ID. | last2 = Tot | first2 = T. | last3 = Jayne | first3 = DG. | last4 = McShane | first4 = P. | last5 = Nihlberg | first5 = A. | last6 = Marshall | first6 = HC. | last7 = Påhlman | first7 = L. | last8 = Brown | first8 = JM. | last9 = Guillou | first9 = PJ. | title = Lymph nodes, tumor deposits, and TNM: are we getting better? | journal = J Clin Oncol | volume = 29 | issue = 18 | pages = 2487-92 | month = Jun | year = 2011 | doi = 10.1200/JCO.2011.34.6429 | PMID = 21555695 }}</ref> and in the context of positive lymph nodes do not change the N stage.
**If no positive lymph nodes are present, the N stage is pN1c.
*The T stage is ''not'' affected by tumour deposits.<ref name=pmid21555695/>
 
Note:
*The definition of ''tumour deposit'' has changed significantly between the TMN/AJCC fifth, sixth and seventh editions.<ref name=pmid21555695/>
 
=====Ueno criteria=====
Ueno ''et al.'' propose that a tumour deposit is either:<ref name=pmid24112678/>
#>=2 mm from the tumour front.
#>=2 mm (radially) from the deepest aspect of the muscularis propria, if the tumour is not present in the plane of section.


===Tumour regression===
===Tumour regression===
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==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 260: 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>


Michael
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