Beyond T, N and M: The impact of tumor deposits on the staging and treatment of colorectal and gastric carcinoma
| Autor: | Nadia Peparini |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Oncology
medicine.medical_specialty Colorectal cancer Gastric carcinoma 030230 surgery 03 medical and health sciences 0302 clinical medicine Neoadjuvant treatment Stomach Neoplasms Internal medicine Rectal carcinoma Medicine Humans Adverse effect Lymph node Neoplasm Staging business.industry Cancer medicine.disease medicine.anatomical_structure 030220 oncology & carcinogenesis Surgery business Colorectal Neoplasms M category |
| Zdroj: | Surgical oncology. 27(2) |
| ISSN: | 1879-3320 |
| Popis: | This review aims to describe the results of the most recent studies on the prognostic value of TDs and highlight the impact of TDs on the staging and treatment of colorectal and gastric carcinoma. For colorectal carcinoma TDs have an adverse prognostic effect that is at least similar to that of positive regional lymph nodes. However, support is growing in favor of including of TDs in the M category, rather than the N or T categories of the TNM classification. Moreover, TDs seem to have an adverse effect on outcomes not only in patients without lymph node involvement but also in patients with nodal involvement. Although the prognostic impact of TDs in gastric cancer appears to be undeniable, the actual prognostic determinants of TDs, particularly in relation to the number, size and histological types, remain to be established. Although the 7th and 8th Edition of the TNM classification of colorectal and gastric carcinoma includes TDs in the N category, no current procedures or methods to assess preoperative or intraoperative N-status allow TD detection. After neoadjuvant treatment for advanced rectal carcinoma, the presence of TDs may indicate incomplete eradication of the main tumor and not discontinuous tumor foci. TDs have an undeniable prognostic impact but no algorithm of staging and strategy of treatment has been conformed to this prognostic factor to overcome the classical T,N, and M prognostic categories. Staging and treatment of colorectal and gastric cancers should be reconsidered in light of the emerging prognostic value of TDs. |
| Databáze: | OpenAIRE |
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