Colon and Rectal Cancers: Pathologic Staging and Assessment

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Pathology Reporting Format in Colorectal Cancer

The pathology report is a critical and powerful tool in colorectal cancer. It contains detailed and definitive anatomic information that determine the stage of locoregional disease and may confirm the presence of distant metastasis, if biopsied at surgery. It also contains microscopic details related to stage-independent prognostic and predictive factors that can help to guide and individualize post-operative care for medical or surgical oncologists. Radiation oncologists may rely on pathological assessment of circumferential margins or tumor regression status following neoadjuvant treatment of rectal cancer to judge the need for or the success of radiation therapy, respectively.

Pathology reports communicate and document essential tumor-specific information used for individual patient management, comparative studies among patients, cancer statistics, and quality of care assessment. Therefore, it is essential that the information contained in pathology reports be both correct and complete. The information also should be presented in manner that is accessible to the users of pathology reports, from patients and patient care givers to tumor registrars and data managers, to allow universal comparability. All of these goals are facilitated by the use of standardized report formats and synoptic rather than narrative reporting.

Recognizing the importance of standardized pathology reporting in cancer medicine, the CAP created a comprehensive set of standardized, state-of-the-science pathology protocols for the assessment and reporting of all major cancers, which it has posted on its website at http://www.cap.org. The Commission on Cancer adopted these protocols as standards of quality care in their Approvals Program since use of such protocols was expected to increase the quality, completeness, and consistency of pathology reports. Indeed, a number of published studies around the world have now clearly demonstrated that the use of standardized pathology reporting formats (e.g., template proformas, checklists, synoptic protocols, etc.) significantly increases the quality of pathology reports, in general, and of pathology reports in colorectal cancer, in specific.80-87 For example, the omission of staging information is dramatically reduced or eliminated by the use of standardized report formats. These formats increase pathology report comprehension and ease of use, and because they increase communication between pathologists and clinicians, they result in improved overall management of the colorectal cancer patient, aiding decision-making regarding adjuvant chemotherapy or radiation therapy and further surveillance.

See the standardized pathology reporting formats listed in the CAP Cancer Protocols and Checklists under Reference Resources and Publications at the CAP website.

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