Future role of the pathologist in reporting colorectal cancer

A pathology report on a surgical specimen of colorectal cancer has prognostic implications and is assuming increasing importance in relation to decisions regarding postoperative adjuvant therapy. The classic pathologic report is a static description of the extent of spread within the surgical specimen. The clinician, on the other hand, needs to know how far the tumor has spread in the patient. For the radiotherapist the report on rectal cancer must include a detailed account of anatomic location and spread, including relations to peritoneum and extent of mesorectal involvement. The oncologist aims to improve survival of patients undergoing "curative" surgery. Untreated, a subset of such patients die of metastatic disease, occult hepatic metastases being present at the time of surgery. An estimate of the risk of micrometastatic disease requires a prognostic classification utilizing independent pathobiologic variables. Reporting of colorectal cancer needs to become more closely tailored to clinical endpoints relevant to therapeutic decision-making. This paper looks critically at current practice and future directions.