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who use it to craft the appropriate treatment plan for a givenindividual. The pathologic stage of the cancer (I-IV) is a combinationof details about the size and depth of the tumor invasion (rangingfrom T1-4), lymph node metastases (N0-2), and any metastatic canceroutside the nodes (M0-1).Additional pathologic studies performed in our lab may includeimmunohistochemical staining of the cancer using antibodies tocertain substances found on tumor cells. This is to clarify exact tumortype in tumors that appear unusual microscopically. Genetic testingis sometimes performed on tumors to look for mutations that suggestgenetic susceptibility to cancer; these are typically performed atreference pathology laboratories on paraffin blocks from our hospital.At St. Anthony’s Medical Center, all 6 board certified pathologists,with a combined 100+ years of practice experience, are trainedto diagnose colorectal specimens. We receive about 20 colorectalspecimens a day, including about 120 colorectal cancer surgicalresections each year. We communicate with our clinical colleagueswho treat these patients via pathology reports, telephone calls, andTumor Conferences, where a multidisciplinary team includingsurgeons, medical and radiation oncologists, radiologists andpathologists discuss cancer cases and develop individualized treatmentplans. This ensures we serve our mission, to provide the best care forevery patient, every day.Dr. LodatoRadiation therapy and rectal cancerRadiation therapy has been used in rectal cancer for some time dueto the problem of local recurrences in the operative bed after surgery.The rationale is based on the anatomical considerations of where therectum lies. As opposed to the colon, which is largely intraperitonealfree floating in the abdomen, the rectum represents the transition ofthe intestinal tract out of the abdomen and to the skin surface at theanus. As such, the large colon transitions from a free floating structureto one that passes outside of the lining of the abdomen into an areathat would be considered retroperitoneal surrounded by fat in thepresacral space. The clinical implication is that cancers that invadeinto the muscular wall of the rectum can extend into the perirectal fatand into the lymph nodes nearby, making the risk for local recurrencequite a bit higher than you would see in colon cancer. This beingthe case, radiation therapy can help sterilize any microscopic diseaseremaining after surgery to help maintain control of the disease.Radiation therapy is also commonly given before surgery to decreaselocal recurrences.Early studies in the use of radiation therapy in the postoperativesetting showed an improvement in local control, but not in survival.13