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Pathology and prognostic determinants of colorectal cancer

Carolyn C Compton, MD, PhD
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD


Carcinoma of the colon or rectum (colorectal cancer [CRC]) is a common and lethal disease. Approximately 134,490 new cases are diagnosed each year in the United States, of which 95,270 are colon and the remainder rectal cancers [1]. Annually, approximately 49,700 Americans die of CRC, accounting for approximately 8 percent of all cancer deaths. Global, country-specific data on incidence and mortality are available from the World Health Organization (WHO) GLOBOCAN database.

Surgical resection is the primary treatment modality for early stage CRC (stage I through III) (table 1), and the most powerful tool for assessing prognosis following potentially curative surgery is pathologic analysis of the resected specimen. Although the parameters that determine pathologic stage are the strongest predictors of postoperative outcome, other clinical, molecular, and histologic features may influence prognosis independent of stage. Among patients with stage IV disease, prognosis is more closely tied to the location and extent of distant metastatic disease.

Here we will discuss the pathology of CRC and the major determinants of prognosis following surgical resection, with particular attention to the strength of the evidence supporting each factor. The molecular pathogenesis of CRC, and the clinical presentation and staging evaluation for colon and rectum cancer are discussed elsewhere. (See "Molecular genetics of colorectal cancer" and "Clinical presentation, diagnosis, and staging of colorectal cancer" and "Pretreatment local staging evaluation for rectal cancer".)


Gross appearance — Although all colorectal cancers (CRCs) originate in adenomas or flat dysplasia, they evolve into different morphologic patterns with invasion and expansion. Tumors in the proximal or right colon usually appear grossly as polypoid or fungating exophytic masses. Occult bleeding may result in the clinical presentation of an unexplained iron deficiency anemia.

In contrast, tumors involving the distal or left colon are more commonly annular or encircling lesions that produce an "apple-core" or "napkin-ring" appearance (image 1A-B). The bowel lumen becomes constricted and narrowed, producing symptoms of bowel dysfunction (eg, constipation, diarrhea, or bowel obstruction). The presence of clinical bowel obstruction or perforation of the bowel wall worsens the prognosis overall [2-4].


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Literature review current through: Sep 2016. | This topic last updated: Apr 8, 2016.
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