Difference between revisions of "Colorectal adenocarcinoma"

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Colorectal adenocarcinoma (view source)

Revision as of 16:47, 10 August 2016

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→‎Tumour deposits: split out
(→‎Tumour deposits: split out)
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*[[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 [[Colorectal_cancer_staging#Nodal_stage|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/>
 
Notes:
*The definition of ''tumour deposit'' has changed significantly between the TMN/AJCC fifth, sixth and seventh editions.<ref name=pmid21555695/>
*Conceptually the same as the ''[[in-transit metastasis]]'' of [[malignant melanoma]]<ref name=pmid19136930>{{Cite journal  | last1 = Puppa | first1 = G. | last2 = Ueno | first2 = H. | last3 = Kayahara | first3 = M. | last4 = Capelli | first4 = P. | last5 = Canzonieri | first5 = V. | last6 = Colombari | first6 = R. | last7 = Maisonneuve | first7 = P. | last8 = Pelosi | first8 = G. | title = Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases. | journal = Mod Pathol | volume = 22 | issue = 3 | pages = 410-5 | month = Mar | year = 2009 | doi = 10.1038/modpathol.2008.198 | PMID = 19136930 }}</ref> and [[dermatopathology]].
*Lesions that are ''not'' in the drainage bed of tumour are [[Colorectal_cancer_staging#Metastasis_stage|metastatic disease]], pM1b.
=====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===
Michael
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