Pathologist and Prognosis

Bryan Warren, Oxford

Powerpoint File

Accurate pathological staging has been the mainstay of delivering prognostic information in colorectal cancer for the last seventy years.

More recently, much more emphasis has been placed on the resection margin rather than just the nodal status. This has developed hand in hadn with more accurate surgical excision of the total mesorectal package. Radiological pre-operative staging is getting more and more accurate particularly with the introduction of MRI and PET scanning. Pathological staging of the resected specimen still remains a gold standard to compare these modern techniques with. A new difficulty has been the presentation to the pathologist of rectums containing cancer, which have been considerably downsized by pre-op chemo-radiation therapy. The current challenges involve – examination of pathological features in downsized and possibly down-staged cancers and relating these features to subsequent prognosis. A summary of a proposed rectal cancer regression grade will be given in order to assess the amount of down-sizing which has occurred and to infer prognosis and some early data related to this prognosis will be presented.