reporting lesions in the nhs bowel cancer screening programme

25.03.2013 Views
14 | Reporting Lesions in the NHS Bowel Cancer Screening Programme 4.5 Tumour grade Poorly differentiated carcinomas are identified either by the presence of irregularly folded, distorted and often small tubules or by the lack of any tubular formation. In the absence of good evidence, we recommend that a grade of poor differentiation should be applied to a polyp cancer when any area of the lesion is considered to show poor differentiation. This differs from the recommendation for major colorectal cancer resections in the Royal College of Pathologists’ dataset, in which grade is determined on the predominant area. Applying the ‘worst area’ criterion will allow all potentially poorly differentiated tumours to be identified for research into which of the two approaches is better for identifying T1 cancers at increased risk of lymph node metastases for major resection without exposing such patients to the possibility of undertreatment. An early review of poorly differentiated pT1 cases will be undertaken. 4.6 Lymphovascular invasion Definite invasion of endothelium lined vascular spaces in the submucosa is generally regarded as a significant risk for lymph node or distant metastasis. Sometimes, retraction artefacts around tumour aggregates can make assessment uncertain, in which case this uncertainty should be recorded and the observation interpreted by the multidisciplinary team in light of any other adverse histological features. 4.7 Margin involvement It is important to record whether the deep (intramural) resection margin is involved by invasive tumour (which may be an indication for further surgery) and whether the mucosal resection margin is involved by carcinoma or pre-existing adenoma (in which case a further local excision may be attempted). There has been considerable discussion and controversy in the literature over the degree of clearance that might be regarded as acceptable in tumours which extend close to the deep submucosal margin. It is important that this is measured and recorded in the report. It is likely that most would regard a clearance of < 1 mm as an indication for further therapy. However, some would use < 2 mm and a few < 5 mm. NHS BCSP September 2007

REFERENCES Reporting Lesions in the NHS Bowel Cancer Screening Programme | 15 1. Konishi F, Morson MC. Pathology of colorectal adenomas: a colonoscopic survey. Journal of Clinical Pathology, 1982, 35: 830–841. 2. Coverlizza S, Risio M, Ferrari A, et al. Colorectal adenomas containing invasive carcinoma: pathologic assessment of lymph node metastatic potential. Cancer, 1989, 64: 1937–1947. 3. Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology, 1995, 108: 1657–1665. 4. Volk EE, Goldblum JR, Petra RE, et al. Management and outcome of patients with invasive carcinoma arising in colorectal polyps. Gastroenterology, 1995, 109: 1801–1807. 5. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology, 1985, 89: 328–336. 6. Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Diseases of the Colon and Rectum, 1995, 38: 1286–1295. 7. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Diseases of the Colon and Rectum, 2002, 45: 200–206. 8. Hamilton SR, Aaltonen LA. Pathology and genetics of tumours of the digestive system. World Health Organization Classification of Tumors, vol. 2. Lyon: IARC Press, 2000. 9. Makinen MJ. Colorectal serrated adenocarcinoma. Histopathology, 2007; 50: 131–135. 10. Halvorsen TB, Seim E. Degree of differentiation in colorectal adenocarcinomas: a multivariate analysis of the influence on survival. Journal of Clinical Pathology, 1988, 41: 532–537. 11. Haboubi N, Geboes K, Shepherd N, Talbot I. Gastrointestinal Polyps. London: Greenwich Medical Media Limited, 2002: 95–123. 12. Jass JR, Williams CB, Bussey HJR, Morson BC. Juvenile polyposis: a pre-cancerous condition. Histopathology, 1988, 13: 619–630. 13. Muto T, Bussey HJR, Morson BC. Pseudocarcinomatous invasion in adenomatous polyps of the colon and rectum. Journal of Clinical Pathology, 1973, 26: 25–31. 14. Ueno H, Mochizuki H, Hashiguchi Y, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology, 2004, 127: 385–394. NHS BCSP September 2007

Page 1 and 2: REPORTING LESIONS IN THE NHS BOWEL

Page 3 and 4: CONTENTS Reporting Lesions in the N

Page 5 and 6: PREFACE Reporting Lesions in the NH

Page 7 and 8: Reporting Lesions in the NHS Bowel


Page 11 and 12: Figure 3 An example of palmate vill

Page 13 and 14: 3.7 Serrated adenomas Reporting Les



Page 19: Reporting Lesions in the NHS Bowel

lesions

screening

polyps

bowel

programme

reporting

bcsp

dysplasia

september

colorectal

www.cancerscreening.nhs.uk

reporting lesions in the nhs bowel cancer screening programme

reporting lesions in the nhs bowel cancer screening programme ... View more reporting lesions in the nhs bowel cancer screening programme

Delete template?

Save as template ?

reporting lesions in the nhs bowel cancer screening programme reporting lesions in the nhs bowel cancer screening programme