Learn the surgical results report of invasive colon cancer

This is an automatically translated article.

The article was written by Specialist Doctor I Nguyen Thi Minh Thuyen - Pathologist, Pathology Department - Vinmec International General Hospital

During colonoscopy and biopsy, the samples taken are processed and studied under a microscope by a specialized doctor with years of training called a pathologist (pathologist). The pathologist will then send the clinician a report giving the diagnostic conclusion for each biopsy specimen. This report helps manage your healthcare. The questions and answers below are intended to help you understand the medical terminology used in the pathology report you receive for your biopsy.

1. What does it mean if the results refer to the cecum, ascending colon, transverse colon, descending colon, sigmoid colon or rectum?

These are all parts of the large intestine (colon). The cecum is the beginning of the large intestine, where the small intestine empties into the large intestine. The ascending colon, transverse colon, descending colon, and sigmoid colon are the other parts of the colon that follow after the cecum. The colon ends in the rectum, where waste products are stored until they come out through the anus.

2. What is adenocarcinoma of the colon (or rectum)?

Adenocarcinoma is a type of cancer that begins in the cells that form the glands that make mucus to lubricate the inside of the colon and rectum. This is the most common type of colon and rectal cancer.

3. What do the words “invasive” or “infiltrate” mean?

When colon cancer grows and spreads beyond the inner lining of the colon (mucosa), it is called invasive (or infiltrative) adenocarcinoma. Invasive cancers are called true cancers, because they can spread to other sites in the body.
Does this mean that the tumor is deeply invasive and has a poor prognosis? That's not always the case. All this means it is a real cancer. A biopsy is only a small part of the tumor taken from inside the colon, so it can't always tell how deep the tumor has invaded the wall of the colon. To find out how invasive the cancer is, the pathologist needs to have a sample of the entire tumor (at the time of surgery).

4. What does differentiation mean?

Differentiation is the grade (histological grade) of the cancer, based on how abnormal the cells are under the microscope. Higher grade or poorly differentiated cancers tend to grow and spread more quickly. Colon cancer is usually divided into 3 grades:
Well-differentiated (low grade) Moderately differentiated (medium-intermediate grade) Poorly differentiated (high grade)

5. What is the significance of grade in colon cancer?

Histological grade is one of many factors that help predict the likelihood of cancer growing and spreading. Poorly differentiated (high grade) colon cancers tend to grow and spread more quickly than well and moderately differentiated colon cancers. However, other factors are also important in determining a patient's prognosis, such as how far the cancer has spread (which cannot be determined on a biopsy).

6. What does vascular, lymphatic, or lymphatic (angiolymphatic) invasion mean?

These terms mean cancer cells are present in the blood vessels or lymphatic vessels of the colon, so it is more likely that the cancer has spread outside the colon. However, this does not mean that your cancer has metastasized or cannot be cured. The presence of this type of invasion may be a factor in a type of treatment that is recommended after cancer removal.

7. What are polyps?

A polyp is a protrusion of tissue from the mucosa into the lumen (hollow center) of the colon. Different types of polyps look different under a microscope. Polyps are benign (non-cancerous) growths, but cancer can originate in several types of polyps.

8. If, in addition to cancer, the report says there are other types of polyps such as adenoma or hyperplastic polyps, what does that mean?

Colon polyps are common lesions. Hyperplastic polyps are usually benign (not cancerous or precancerous) and are not a cause for concern. But different types of adenomatous polyps (adenomas) need to be removed. However, if polyps are present with cancer elsewhere in the colon, they usually do not affect the treatment or monitoring of the cancer.

9. What does the mucus (mucin) mentioned in the report mean?

Mucus secreted by the colon for lubrication. Colon cancer that secretes large amounts of mucus is called mucinous adenocarcinoma.

10. If the biopsy results refer to special tests such as satellite instability (MSI) and what are MSH2, MSH6, MLH1 and PMS2?

In some colon cancers, special tests can show abnormalities called satellite instability or MSI (microsatellite instability) in cancer cells. Satellite instability is associated with defects (mutations) in several mismatch repair (MMR) genes, including MSH2, MSH6, MLH1, and PMS2. Inherited defects in these genes can lead to a disease called Lynch syndrome or hereditary nonpolyposis colon cancer (HNPCC).
If your cancer is found to have an MSI or a defect in the MMR gene, your doctor may recommend genetic counseling and blood tests to see if you have Lynch syndrome. Along with having a higher risk of colon cancer, people with Lynch syndrome have an increased risk of several other cancers. Other family members who inherit the same gene mutation also have a higher risk of developing these cancers.
MSI test results can also affect your colon cancer treatment. For example, early-stage cancers with low levels of MSI (or no MSI) may require more aggressive treatment than other early-stage cancers.

11. What if the biopsy results refer to special tests like KRAS, NRAS and BRAF?

These tests help detect changes in the KRAS, NRAS and BRAF genes in cancer cells. For people with more advanced colon cancer, these tests can help determine if you would benefit from treatment with certain drugs (called targeted drugs or targeted therapy). destination). In other words, they are used to help your doctor determine the best treatment for you. Although these tests detect certain gene mutations, they are not related to genetic counseling or testing. They only provide information about your cancer and the exact type of treatment you may need. Remember that not every patient with colon cancer needs other types of treatment besides surgery.
Patients can rely on the above explanations to understand the surgical results of invasive colon cancer. In addition, the patient should also discuss more with the doctor to understand the treatment direction of the current medical condition.
Currently Vinmec International General Hospital is one of the hospitals that ensures modern equipment, a team of doctors, good and experienced staff with leading professors and doctors at home and abroad, Advanced testing and prevention systems allow the implementation of the most advanced diagnostic and treatment techniques. In particular, the most prominent is a new technique - Robotic surgery with a hand-held robot for colorectal cancer treatment. This method has many advantages compared to both classical laparoscopic and robotic surgery such as: Instruments with surgical heads act as flexibly as wrist joints to help access narrow angles, increase dissection and less causing damage to the surrounding areas compared with classical laparoscopic surgery, endoscopic lights automate through voice, laser, eye tracking, ... helping the doctor to actively control and have vision and attention. Better control, increased accuracy and safety in performing surgery. With the advantage of compactness, minimally invasive robotic arm surgery has many advantages such as small incision, less pain, low risk of infection, thereby helping customers to lose less blood during surgery and recover quickly. The cost is much lower than robotic surgery. As a result, the treatment results are always appreciated and help the patient's health recover well, soon stabilize life.

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Article referenced source: American Cancer Society