A916: rectum: adenocarcinoma

Transcription

1 General facts of colorectal cancer The colon has cecum, ascending, transverse, descending and sigmoid colon sections. Cancer can start in any of the r sections or in the rectum. The wall of each of these sections (and rectum) has several layers of tissues. Cancer starts in the inner layer and can grow through some or all of the other layers. Knowing a little about these layers is helpful because the stage (extent of spread) of a cancer depends to a great degree on which of these layers it affects. Cancer that starts in the different areas may cause different symptoms. Colon and rectum cancers probably develop slowly over a period of several years. We now know that most of these cancers begin as a polyp--a growth of tissue into the center of the colon or rectum. Polyps are also known as adenomas. Removing the polyp early may prevent it from becoming cancer. Over 95% of colon and rectal cancers are adenocarcinomas. These are cancers of the cells that line the inside of the colon and rectum. There are some other, more rare, types of tumors of the colon and rectum, but the facts given here refer only to adenocarcinomas. Colon and rectal cancer have many features in common and are often referred to together as colorectal cancer. Treatment Surgery is the main treatment for cancer of the large bowel. It may be used either alone, or in combination with radiotherapy and chemotherapy. The treatment will depend on the stage of the cancer (its position, size and whether it has spread). This is decided through the results of various tests and what is discovered during surgery. Sometimes doctor may advise other treatment before surgery. This is because the results of the tests and scans have already given the doctor a good idea of the stage of the cancer. Many people need to have surgery to remove the cancer. If the cancer is an early stage (Dukes A= Stage I), the aim of surgery is to completely remove the cancer, and this may cure it. In situations where the cancer is advanced and causing a blockage (obstruction) of the bowel, surgery may be used to remove this. This will not cure the cancer, but can relieve symptoms. Chemotherapy is often given after surgery to try to reduce the chances of the cancer coming back. It is also given when the cancer is advanced and has spread to other parts of the body. In some people, both radiotherapy and chemotherapy are combined and given together before surgery is carried out. This is called chemoradioation. Radiotherapy is usually only used to treat cancer of the rectum and can be given before or after surgery.

2 Primary tumor (T) Staging of colorectal cancer TX: Primary tumor cannot be assessed T0: No evidence of primary tumor Tis: Carcinoma in situ : intraepithelial or invasion of the lamina propria : Tumor invades submucosa T2: Tumor invades muscularis propria T3: Tumor invades through the muscularis propria into the subserosa, or into nonperitonealized pericolic or perirectal tissues T4: Tumor directly invades other organs or structures, and/or perforates visceral peritoneum Regional lymph nodes (N) NX: Regional nodes cannot be assessed N0: No regional lymph node metastasis : Metastasis in 1 to 3 regional lymph nodes N2: Metastasis in 4 or more regional lymph nodes Distant metastasis (M) MX: Distant metastasis cannot be assessed M0: No distant metastasis M1: Distant metastasis Stage Stage Stage Stage Stage 0 Tis, N0, M0 I, N0, M0 T2, N0, M0 IIA T3, N0, M0 IIB T4, N0, M0 IIIA,, M0 T2,, M0 IIIB T3,, M0 T4,, M0 IIIC Any T, N2, M0 IV Any T, Any N, M1 References 1. Colon and rectum. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp

3 Lot. No : Fig3. RT-PCR for GAP3DH / AGE: 56 Sex: Female Stage: T3M1 1.Rectum, segmental resection: Ulceroinfiltrating adenocarcinoma, moderately differentiated, extending into perirectal fat tissue with 1) occasional lympho vascular permeation and frequent perineural invasion. 2) resection margins, proximal and distal: Free of tumor. 3) resection margin, lateral: Extension of tumor. 4) regional lymph nodes, principal (1/1), perirectal (1/18) : (2/19): 5) metastatic adenocarcinoma in 2 out of 19 nodes with perinodal tumor extension. * Post operation: chemotheraphy (5FU,Levorin) * Comment: hypothyroidism

4 Lot. No : Skin Fig 2. Scanned images for H&E stained slides. Skin Fig3. RT-PCR for GAP3DH Sample : Serial 10 sections of Skin / AGE: 44 Sex: Female Stage: T2N0M0 1.Rectum, Mile's operation: Adenocarcinoma, well differentiated, fungating type 1) extension to proper muscle layer without invasion into perirectal fat and vaginal wall 2) marked peritumoral inflammatory infiltrate and fibrosis. 3) resection margins, proximal and distal: Free of tumor. 4) regional lymph node, principal (0/0), perirectal (0/26): Free of tumor.

5 Lot. No : / AGE: 69 Sex: Male Stage: T3N2M0 1.Rectum with perirectal soft tissue, Miles' operation: Ulcerofungating adenocarcinoma, moderately differentiated, 1) size: 4x3.8cm 2) infiltrating growth 3) penetration of muscle layer and extension to perirectal soft tissue 4) vascular and perineural invasion 5) intact proximal and distal(anus) resection margins but extension to lateral one 6) metastasis to 8 out of 41 perirectal lymph nodes (perirectal (8/32), principal (0/9)) 7) two tubular adenomas with low to focal high grade dysplasia the surrounding mucosa * Post operation: adjuvant chemotheraphy (5Fu, Leorin) * Comments: with hepatocellular carcinoma

6 Lot. No : / AGE: 72 Sex: Male Stage: T3N0M0 1.Rectum, low anterior resection: Adenocarcinoma, moderately differentiated, ulcerative type with 1) extension to the perirectal fat tissue. 2) resection margins, proximal, distal and lateral: Free of tumor. 3) lymph nodes, regional (0/16): Free of tumor. 2.Soft tissue, separately submitted as principal node: Free of tumor. * Comments: smoking 50 years

7 Lot. No : Fig3. RT-PCR for GAP3DH / AGE: 38 Sex: Male Stage: T3N2M0 1. Rectum, low anterior resection: Ulcerofungating adenocarcinoma moderately differentiated with 1) size: 6.2x5.2cm 2) infiltrative growth 3) extension to perirectal soft tissue but intact lateral resection margin 4) no vascular and perineural invasion 5) intact proximal and distal resection margins 6) metastasis to 5 out of 29 perirectal lymph nodes ( principal (0/9) and perirectal (5/20) ) MSI(Microsatellite instability) test Marker Name bat26 D5S346 bat25 D17S250 D2S123 Microsatellite No No No No No MSS instability Allelic uninformative uninformative No (0.79) No (1.28) Imbalance * Post operation: adjuvant chemotheraphy (5FU,Levorine)

8 Lot. No : Stomach Stomach Fig3. RT-PCR for GAP3DH Stomach / AGE: 73 Sex: Male Stage: T3N2M0 1.Rectum with perirectal soft tissue, Mile's operation: Ulceroinfiltrative adenocarcinoma, moderately differentiated, 1) size: 4.5x2.3cm. 2) infiltrative growth. 3) penetration of muscle layer and extension to perirectal fatty tissue. 4) perineural invasion but not vascular invasion. 5) intact proximal and distal resection margins. 6) metastasis to 5 out of 24 regional lymph nodes ( principal (0/1), perirectal(5/23) ). 7) surrounding mucosa showing tubular adenomas with low grade dysplasia. 2.Artery, clinically right internal iliac, segmental resection: Atherosclerosis. * Post operation: adjuvant chemotheraphy (5FU,Levorin)

9 A916: rectum: adenocacinoma Lot. No : / AGE: 69 Sex: Female Stage: T3M0 1.Rectum, segmental resection: Adenocarcinoma, moderately differentiated, ulceroinfiltrative type 1) extension to perirectal fat tissue without vascular permeation or perineural invasion. 2) resection margins, proximal and distal: Free of tumor. 3) esection margin, lateral: see note. 4) regional lymph nodes, principal (0/1), perirectal (1/17) : (1/18): Metastatic adenocarcinoma in one out of 18 nodes with perinodal tumor extension. Note: The tumor is very close to the lateral margin (about 0.6mm).

10 Lot. No : / AGE: 60 Sex: Male Stage: T3M0 1.Rectum, anterior resection: Adenocarcinoma, moderately differentiated, 1) ulcerofungating type. 2) size: 4.5x4.0cm 3) extension to perirectal fat tissue. 4) very close to lateral margin (within 0.5mm). 5) no lymphovascular permeation. 6) Tubular adenoma with low grade dysplasia. 7) regional lymph nodes, principal (0/2), peri-rectal (2/24):(2/26): Tumor metastasis in 2 out of 26 nodes. 8) separately submitted nodes with perinodal tumor extension: Tubular adenoma with low grade dysplasia. * Post operation : adjuvant chemotheraphy (5FU, Leucovorin). * Comments: alcohol

11 A916 rectum: adenocarcinoma Lot. No : N / AGE: 68 Sex: Female Stage: T3N0M1 1.Rectum, anterior resection: Adenocarcinoma, moderately differentiated, ulcerofungating type 1) extension to perirectal fat tissue and very close to serosa (<0.8mm). 2) resection margins, proximal and distal: Free of tumor. 3) regional lymph nodes, principal (0/10), perirectal (0/29):(0/39): Free of tumor.

12 Lot. No : / AGE: 56 Sex: Male Stage: T3N0M0 1.Rectum, Hartmann's operation: Adenocarcinoma, moderately differentiated, fungating type, 1) extension to the peirectal fat tissue and extensive lymphatic invasion. 2) resection margins, proximal and distal: Free of tumor. 3) lymph nodes, regional(0/11) and principal(0/0): Free of tumor metastasis in all 11 nodes. * Post operation: adjuvant chemotheraphy (5FU,Leucovorin)

13 A916: colon(rectum): adenocarcinoma Lot. No : for H&E stained slides / AGE: 62 Sex: Female Stage: T2N0M0 1.Total colorectum and terminal ileum, total colectomy: Fungating adenocarcinoma, moderately differentiated, arising from adenomatous polyp 1) size: 3.5x3cm. 2) expanding growth. 3) involving submucosal space and extending to proper muscle layer. 4) intact proximal and distal resection margins. 5) no metastasis to regional pericolic lymph nodes (0/72) and principal lymph node(0/0). 6) non-neoplastic mucosa showing multiple (about 30) adenomatous polyp i ncluding tubular and tubulovillous adenomas with low to high grade dysplasia. 2.Appendix, appendectomy, separately submitted: Free from tumor extension.

14 Lot. No : / AGE: 65 Sex: F Stage: T3N0M0 1.Rectum, segmental resection: Adenocarcinoma, well differentiated, ulceroinfiltrative, with 1) extension to the perirectal fat tissue 2) occasional lymphatic invasion. 3) resection margins, proximal and distal: Free of tumor. 4) lymph nodes, regional (0/21) and principal (0/2): Free of tumor metastasis in all 23 nodes. * Post operation :adjuvant chemotheraphy