Rectal Cancer and Invasion of Veins: Importance in TNM Staging 2

Kiss Roland,Kiss Lorant

doi:10.4172/2165-7831.1000144

Abstract

Abstract Summary: Accurate information about infiltration of the tumor to the various layers of the rectal wall is important. Material and methods: A histopathological study of surgical specimens from 351 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52%. Results: Follow-up studies showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present. Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thick–walled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick–walled extramural veins, had greatest adverse influence of all. Venous spread of tumor takes place in parallel with local spread as measured by the Dukes’ stage but exerts an influence on prognosis independent of the Dukes’ stage. Similarly, veins invasion parallels the number of lymph nodes metastases but appears to exert an independent influence on prognosis. Conclusion: The venous spread provides a precise assessment of the likely behavior of rectal cancer, but does not replace indices such as the Dukes’ stage, or the number of lymph nodes metastases in use.

Highlights

Once a diagnosis of rectal cancer has been confirmed histologically, preoperative staging is mandatory to assist therapeutic decision making [1].Today, several imaging modalities of great potential exist for local staging, including three-dimensional reconstruction [2,3,4]
Veins invasion parallels the number of lymph nodes metastases but appears to exert an independent influence on prognosis
Of the patients who died the cause of death was confirmed by autopsy in only 17 cases, but liver metastases were found at primary operation or at subsequent laparotomy in 44 cases

Summary

Introduction

Several imaging modalities of great potential exist for local staging, including three-dimensional reconstruction [2,3,4]. Since the initial report by Brown and Warren in 1938 demonstrating an increase in visceral metastases on patients with rectal cancer with vascular invasion, a number of investigators have examined the influence of vascular invasion by tumor in colorectal cancer. They are two type of vascular invasion: blood vessel and lymphatic vessel invasion [5]. One would predict the presence of vascular invasion to be associated with an increased incidence of lymph nodes metastases and distant dissemination and with a decrease in survival [6]

Methods

Results

Conclusion