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Figure 14.1 Cancer of the colon and rectum — information for the pathologist CANCER OF THE COLON AND RECTUM — INFORMATION FOR THE PATHOLOGIST The following special information should be recorded for the pathologist in addition to the usual information supplied when requesting histopathological examination. This special information will enable the pathologist to use the Australian Clinicopathological Staging System in this report. Name Mark location of tumour on diagram Mark lines of resection on diagram Name of operation performed: Was operation: � curative (no obvious tumour remaining) � palliative (tumour remaining) If distant metastases present: State site(s) Biopsy taken � yes � no M.O. Signature............................... Ag e Sex File no. If palliative, the reason was: � tumour transected � metastases remaining � both Was adjacent organ(s) or tissue excised with bowel � yes � no Staging and reporting 163
14.4 Translation between staging systems A matrix for translating between staging systems was developed by a working party on staging, which reported in 1990. 12 The international comprehensive anatomical terminology (ICAT) for Colorectal Cancer and matrix for staging conversion is shown in Table 14.4. 13 14.5 Additional information on pathology Apart from tumour stage, the importance of including information on a range of other variables in the histopathology report is recognised, (refer to Table 14.5). These variables include the components of stage and some other factors that have been shown to have a bearing on prognosis. The independent prognostic effects of many of these variables have been assessed within the ACPS system and have been demonstrated to be stage dependent. 12,14,15 The pTNM staging system uses an alphanumeric shorthand method of defining the extent of tumour spread. This terminology is detailed but it does not permit the separate designation of cases where tumour spread specifically involves a free serosal surface. This aspect of tumour spread has been shown to be an important prognostic variable. 14–16 As has been mentioned, the code for local residual tumour (the R classification) is optional. Table 14.5 Reporting on Colorectal Cancer specimens The following list of variables should be addressed when reporting on Colorectal Cancer specimens: 1. Extent of direct spread of tumour (submucosa, muscularis propria, subserosa, free serosal surface, adjacent organ/structure, surgical lines of resection). Distance of tumour from longitudinal margins, radial margins and anal verge (in those having an abdominoperineal resection). 2. Lymph node involvement (number of involved nodes, presence or absence of extracapsular extension, apical node involved or not). The number of nodes examined should be recorded as a guide to the adequacy of the lymph node harvest. 3. Lymphovascular invasion present or absent. 4. Perineural invasion present or absent. 5. Tumour histology • tumour type (adenocarcinoma, mucinous adenocarcinoma*, signet ring cell*, large cell undifferentiated*) • grade of differentiation (well, moderately or poorly differentiated) • margin (expanding or infiltrating) • peritumoural and tumour infiltrating lymphocytes* • presence or absence of necrosis in those patients having preoperative adjuvant therapy 6. Histology of any biopsy material. * Histological variables are useful diagnostic markers for hereditary nonpolyposis colon cancer (HNPCC) and sporadic cancers showing microsatellite instability (MSI). 17,18 164 The prevention, early detection and management of colorectal cancer
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Clinical Practice Guidelines FOR TH
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© The Cancer Council Australia/Aus
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2.11 Conclusions...................
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11.2 High ligation ................
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17.4 Cost effectiveness of follow u
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Table 14.3 Pathological TNM staging
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Executive Summary • Colorectal Ca
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STRENGTH OF RECOMMENDATIONS 2,3 The
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Should red meat intake be altered t
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Chapter Recommendations 4 COMMUNICA
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Chapter 8 Recommendations How shoul
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Chapter Recommendations Should bowe
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Chapter Recommendations When should
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Chapter 17 Recommendations What pos
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Section I Early Colorectal Cancer
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Adenomatous polyps (adenomas) are b
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17. South Australian Cancer Registr
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CHAPTER 2 PRIMARY PREVENTION Studie
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Colorectal adenomas, especially adv
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vegetable (3.5 serves/1000 kcals) d
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mustard greens, swedes and turnips)
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for protection against Colorectal C
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Does selenium supplementation reduc
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the optimal duration of use, and ad
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References 1. Jass JR. Pathogenesis
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34. Kushi L, Giovannucci E. Dietary
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67. Fearon ER, Vogelstein B. A gene
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100. Il'yasova D, Hodgson ME, Marti
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133. Meyskens FL, Jr., Gerner EW. D
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CHAPTER 3 POPULATION SCREENING FOR
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studies also demonstrate that age i
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• symptoms • family medical his
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Should screening be recommended? Gu
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Box 3.3 Screening Pathway used in t
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References 1. Young GP, Levin B, Ro
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33. Alexander F, Weller D. Evaluati
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CHAPTER 4 COMMUNICATION WITH THE PA
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4.6 Coordination of care Treatment
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• assistance with and care of chi
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17. National Breast Cancer Centre,
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CHAPTER 5 THE PATIENT WITH SYMPTOMS
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considered (see 8.1.5). Double cont
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58 The prevention, early detection
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diagnoses prove difficult to confir
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What recommendations are there for
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References 1. Woolf CM. A genetic s
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34. Australian Health Technology Ad
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CHAPTER 7 HIGH-RISK FAMILIAL COLORE
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offered predictive genetic testing.
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endoscopically uncontrollable numbe
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mutation carriers. 52 There is also
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standard for consideration of MSI a
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added to transvaginal ultrasound. 8
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category 2, see Chapter 6) but may
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What screening is recommended for e
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References 1. Vasen HF, Griffioen G
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33. Giardiello FM, Hamilton SR, Kru
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international criteria for the dete
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96. Burt RW, Jass JR. Hyperplastic
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8.1.2 Sigmoidoscopy: rigid versus f
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For radiological imaging of the lar
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8.2.3 Staging for distant metastase
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The feelings and fears of the patie
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18. Rex DK, Cutler CS, Lemmel GT et
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52. Liu SK, Church JM, Lavery IC, F
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104 The prevention, early detection
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strong family history of Colorectal
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A screening interval of 4-6 years i
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BRAF mutation, particularly when mu
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Page 157 and 158: Total or subtotal colectomy may be
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Page 165 and 166: etween 1993 and 1999. The local rec
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Page 181 and 182: A clinical diagnosis of large bowel
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Page 189 and 190: Table 14.1 Clinicopathological stag
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CHAPTER 19 RECURRENT AND ADVANCED C
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What are the recommendations for in
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References 1. National Health and M
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31. Phillips RK, Hittinger R, Bleso
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Recurrent and advanced colorectal c
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(23% compared to 12%, p
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more patients having disease down-s
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References 1. Best L, Simmonds P, B
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30. Fuchs CS, Moore MR, Harker G, V
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CHAPTER 21 MANAGEMENT OF LIVER AND
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21.1.3 Imaging controlled destructi
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Does combination systemic chemother
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References 1. Woodington FF, Waugh
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34. Wood BJ, Ramkaransingh JR, Fojo
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66. Headrick JR, Miller DL, Nagorne
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Management of liver and other dista
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years gained can be assessed, which
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‘If neither of the above cases ap
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Study Country Study questions Concl
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Study Country Comparator/ screening
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Three United States studies investi
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Table 22.6 Results of studies inves
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22.9 Treatments 22.9.1 Surgery Seve
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Table 22.10 Results of studies inve
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Table 22.11 Summary of findings fro
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References 1. Australian Institute
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32. Nakama, H., B. Zhang, and A.S.
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65. Sieg, A., et al., Screening for
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97. Durand-Zaleski, I., et al., Eco
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Cost effectiveness 289
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References 1. National Health and M
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Appendices
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“Zorbas et al 2 Multidisciplinary
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a pathologist-molecular biologist o
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References 1. Australian Cancer Net
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Chapter 2 — Primary prevention an
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Three Cochrane systematic reviews w
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Dates 1 January 1998 to June 2004 S
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Dates Update of 1999 document from
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Search terms MeSH terms were ‘col
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Chapter 20 — The role of systemic
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Search terms Colorectal Cancer, soc
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However, in some cases it was also
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Professor James St John Gastro ente
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Working party on emergency surgery
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Dr Russel Stitz Surgeon, Royal Bris
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14. Dr Michael Izard Radiation Onco
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Mrs Avis Mcphee Consumer (June 9 an
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DVT deep venous thrombosis ECOG Eur
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TNM tumour, node, metastasis stagin
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Chemotherapy The use of drugs (whic
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Malignant Cancerous Malignant cells
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with a specific disease might survi
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