Key Issues in Reporting Common Cancer Specimens: Problems in Pathologic Staging of Colon Cancer

Abstract

Abstract Context.—Standardized pathologic assessment is a quality measure for cancer care. Objective.—Pathologic staging parameters and the clinically important stage-independent pathologic factors that pathologists find most problematic to evaluate in colorectal cancer resection specimens are reviewed. The objective of this review is to provide practical guidance for the practicing surgical pathologist. Data Sources.—Published literature related to the TNM staging system for colorectal cancer of the American Joint Committee on Cancer and the International Union Against Cancer and to stage-independent tissue-based prognostic factor evaluation was included in the review. Study Selection, Data Extraction, and Synthesis.—Published guidelines from authoritative sources and published peer-reviewed data related to colorectal cancer staging and pathologic prognostic factor assessment were included for consideration. The general and site-specific rules of application of the American Joint Committee on Cancer and International Union Against Cancer TNM staging system for the colorectum and the protocol for evaluation of colorectal cancer resection specimens of the Cancer Committee of the College of American Pathologists served as the basis for discussion and amplified with practical advice on specific application. Conclusions.—Standardization of pathologic evaluation of colorectal cancer resection specimens is essential for optimal patient care and is aided by the use of data-driven guidelines that are easily understood and consistently applied.