Dlroadruck wrote:... I'm not sure where else that info might be located...
According to the NCCN Guidelines on Colon Cancer, Stage 2 patients can be divided into three categories for purposes of determining appropriate subsequent treatment.
This information is shown on page 9 of the NCCN Colon Cancer Guidelines:
https://www.tri-kobe.org/nccn/guideline/colorectal/english/colon.pdfYou can see the three categories near the top of page 9, They can be summarized as,
- 1. T3N0M0 with MSH-H or dMMR
- 2. T3N0M0 with MSH-L or MSS, and no high risk features
- 3. T3N0M0 with high risk features.
Thus, the two main factors that determine which category you are in are (a) your MSI status, and (b) the number of high risk factors from the pathology report
You can see from Footnote
m how they define the seven high risk factors that they use:
- Poorly differentiated histology
- Lymphatic/ vascular invasion
- Bowel obstruction
- < 12 lymph nodes examined
- Perineural invasion
- Localized perforation
- Close, indeterminate or positive margins
In the diagram on page 9, the horizontal arrow to the right of each category points to the type of adjuvant treatment (if any) recommended for that particular category of Stage 2.
You can ask your doctors if they are using the NCCN Guidelines, or if they are using some other system for staging. You need to have both your MSI results and your pathology report to use the NCCN system.
If you want to see how some of these terms are defined, you can read the article below. Table 2 on page S350 has a summary checklist of a typical pathology report.
http://www.siapec.it/content/file/2873/colorectal%20tumours%20the%20histology%20report%20G%20Lanza%20et%20al.pdfHere's another article:
Understanding Your Pathology Report: Colon Cancer https://www.oncolink.org/cancers/gastrointestinal/colon-cancer/treatments/understanding-your-pathology-report-colon-cancerHere's a typical path report template:
Path Report Template
Table 2
Surgically resected specimens of colorectal cancer – Checklist
Tumor site:
Cecum
Ascending colon
Hepatic flexure
Transverse colon
Splenic flexure
Descending colon
Sigmoid colon
Rectosigmoid junction
Rectum
Tumor size
Maximum tumor diameter: cm
Histologic type
Adenocarcinoma
Mucinous adenocarcinoma
Signet-ring cell carcinoma
Small cell carcinoma
Squamous cell carcinoma
Adenosquamous carcinoma
Medullary carcinoma
Undifferentiated carcinoma
Other (specify):
Grade of differentiation
Low grade (well or moderately differentiated)
High grade (poorly differentiated or undifferentiated)
High grade component (%):
Depth of tumor invasion
No evidence of primary tumor
Tumor invades submucosa (pT1)
Tumor invades muscularis propria (pT2)
Tumor invades through the muscularis propria into the subserosal adipose
tissue or the nonperitonealized pericolic or perirectal soft tissues (pT3)
Tumor penetrates to the surface of the visceral peritoneum (serosa)
(pT4a)
Tumor directly invades other organs or structures
(specify:) (pT4b)
Tumor penetrates to the surface of the visceral peritoneum (serosa) and
directly invades other organs or structures
(specify: ) (pT4b)
Margins of resection
Proximal/distal margin
Cannot be assessed
Invasive carcinoma present
Invasive carcinoma absent
Distance of invasive carcinoma from closest margin:
mm
Circumferential (radial) margin
Not applicable
Cannot be assessed
Invasive carcinoma present
Invasive carcinoma absent
Distance of invasive carcinoma from non-peritonealised margin:
mm
Regional lymph nodes
Number examined:
Number involved:
Tumor deposits
Not identified
Present (number: )
Response to neoadjuvant therapy
Not applicable (no prior treatment)
Complete regression
Minimal residual tumor
No marked regression
Extramural venous invasion
Not identified
Present
Pathologic staging (pTNM)
TNM descriptors
(required only if applicable)
m (multiple primary tumors)
r (recurrent)
y (posttreatment)
Primary tumor (pT)
pTX: Cannot be assessed
pT0: No evidence of primary tumor
pTis: Carcinoma in situ, intraepithelial or invasion of lamina propria
pT1: Tumor invades submucosa
pT2: Tumor invades muscularis propria
pT3: Tumor invades through the muscularis propria into pericolorectal
tissues
pT4a: Tumor penetrates the visceral peritoneum
pT4b: Tumor directly invades other organs or structures
Regional lymph nodes (pN)
pNX: Cannot be assessed
pN0: No regional lymph node metastasis
pN1a: Metastasis in 1 regional lymph node
pN1b: Metastasis in 2 to 3 regional lymph nodes
pN1c: Tumor deposit(s) in the subserosa, or nonperitonealized pericolic
or perirectal tissues without regional lymph node metastasis
pN2a: Metastasis in 4 to 6 regional lymph nodes
pN2b: Metastasis in 7 or more regional lymph nodes
Distant metastasis (pM)
Not applicable
pM1: Distant metastasis
Specify site(s):
pM1a: Metastasis to single organ or site (e.g., liver, lung, ovary,
nonregional lymph node)
pM1b: Metastasis to more than one organ/site or to the peritoneum
Additional pathologic findings
None identified
Diverticular disease, ulcerative colitis, Crohn’s disease, familial
adenomatous polyposis, other forms of polyposis, synchronous
carcinoma(s) (complete a separate form for each cancer), etc.
Specify:
Polyps present (specify type and number):
Comments
Reference:
" Recommendations for the Reporting of Surgically Resected Specimens of Colorectal Carcinoma" ASCPJournal