Cancers 2011, 3(1), 164-181; doi:10.3390/cancers3010164
Review

Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms

Received: 28 October 2010; in revised form: 27 December 2010 / Accepted: 29 December 2010 / Published: 4 January 2011
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract: Transmural spread by colorectal carcinoma can result in tumor invasion of the serosal surface and, hence, more likely dissemination within the peritoneal cavity and potentially to additional metastatic sites. The adverse prognostic significance of serosal invasion is widely accepted and its presence may be considered an indication for chemotherapy in patients with node negative disease. However, controversy persists regarding the most appropriate criteria for diagnosis and there are also practical difficulties associated with histological assessment in some cases. Therefore, serosal invasion may be under-diagnosed in a significant proportion of tumors, potentially leading to sub-optimal treatment of high-risk patients. The examination of multiple microscopic sections combined with ancillary studies such as cytology preparations, elastin stains, and immunohistochemistry may prove beneficial in selected problematic cases, but these are not used routinely. The relative prognostic significance of serosal invasion and of direct tumor spread to other organs, both of which are incorporated within the pT4 category of the AJCC/UICC TNM staging system, remains unclear. Further studies are required to demonstrate whether recent adjustments to the TNM staging of pT4 tumors are appropriate.
Keywords: colorectal; carcinoma; serosa; invasion; TNM; T4; stage; elastin; immunohistochemistry
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MDPI and ACS Style

Stewart, C.J.R.; Hillery, S.; Platell, C.; Puppa, G. Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms. Cancers 2011, 3, 164-181.

AMA Style

Stewart CJR, Hillery S, Platell C, Puppa G. Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms. Cancers. 2011; 3(1):164-181.

Chicago/Turabian Style

Stewart, Colin J. R.; Hillery, Simon; Platell, Cameron; Puppa, Giacomo. 2011. "Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms." Cancers 3, no. 1: 164-181.

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