Table 1 Survey questions consisting of multiple case scenarios pertaining to treatment-naive colorectal carcinoma
From: Challenges with colorectal cancer staging: results of an international study
Presented case scenarios/survey questions | Answer choices | Responses (percentages) |
|---|---|---|
1. H&E section from surgical resection of untreated colon cancer shows viable tumor that is >1 mm from the serosal surface but is continuous with the peritoneal surface through inflammation. a. How will you stage this tumor? | a. pT3 (tumor invades through the muscularis propria into pericolorectal tissues) | 49% |
b. pT4a (tumor invades through the visceral peritoneum (including gross perforation of the bowel through tumor and continuous invasion of tumor through areas of inflammation to the surface of the visceral peritoneum)) | 51% | |
b. Do you consider this as tumor perforation? | a. Yes | 30% |
b. No | 70% | |
c. Does granulation tissue count in the above scenario? | a. Yes | 42% |
b. No | 58% | |
2. H&E section from surgical resection of untreated colon cancer wherein the tumor is identified <1 mm from serosal surface, but with no serosal involvement (despite multiple sections) is considered as pT3 per American Joint Committee on Cancer staging 8th edition manual/College of American Pathologists protocol. In this scenario, do you give the distance of the tumor from serosal surface and/or add a comment about the likely higher risk of peritoneal recurrence? | a. Yes | 53% |
b. No | 47% | |
3. Left hemicolectomy of an untreated colonic carcinoma yields 40 lymph nodes. One of the 40 lymph nodes show tumor cells measuring <0.2 mm. In your clinical practice, do you stage this as negative lymph node (with isolated tumor cells) or positive lymph node (currently defined as tumor in lymph nodes measuring >0.2 mm)? | a. pN1 (one to three regional lymph nodes are positive (tumor in lymph nodes measuring ≥0.2 mm)) | 48% |
b. pN0 (with isolated tumor cells, defined as being <0.2 mm) | 47% | |
c. pN0 (no regional lymph node metastasis) | 5% | |
4. Left hemicolectomy of an untreated colonic carcinoma yields 35 lymph nodes. Two of the 35 lymph nodes show acellular mucin with no viable tumor cells (despite multiple deeper levels). This should be staged as: | a. pN0 (no regional lymph node metastasis) | 67% |
b. pN1b (two or three regional lymph nodes are positive) | 33% |
