ABSTRACT
The management of colorectal liver metastases has been improved these last years. The efficacy of chemotherapy regimens and targeted therapies has led to a better prognosis. It has also allowed the resection of metastases initially unresectable. In this setting, the pathologist plays a major role. He is involved in the gross examination, in order to perform an adequate sampling of the lesions. He is also involved at the morphological level, for the assessment of the pathological response, which is now recognized as a prognostic factor and a marker of sensitivity or resistance to a given treatment. Moreover, the determination of predictive markers of response or resistance to induction treatments will constitute a supplementary and major challenge for the pathologist.
Subject(s)
Adenocarcinoma/secondary , Antineoplastic Agents/therapeutic use , Colorectal Neoplasms/pathology , Induction Chemotherapy , Liver Neoplasms/secondary , Pathology, Clinical , Physician's Role , Adenocarcinoma/chemistry , Adenocarcinoma/drug therapy , Adenocarcinoma/surgery , Antineoplastic Agents/adverse effects , Biomarkers, Tumor/analysis , Chemical and Drug Induced Liver Injury/etiology , Combined Modality Therapy , Disease Management , Humans , Interdisciplinary Communication , Liver Neoplasms/chemistry , Liver Neoplasms/drug therapy , Liver Neoplasms/surgery , Molecular Targeted Therapy , Neoplasm Grading , Prognosis , Treatment OutcomeABSTRACT
Locally advanced rectal cancers mainly correspond to lieberkünhien adenocarcinomas and are defined by T3-T4 lesions with or without regional metastatic lymph nodes. Such tumors benefit from neoadjuvant treatment combining chemotherapy and radiotherapy, followed by surgery with total mesorectum excision. Such a strategy can decrease the rate of local relapse and lead to an easier complementary surgery. The pathologist plays an important role in the management of locally advanced rectal cancer. Indeed, he is involved in the gross examination of the mesorectum excision quality and in the exhaustive sampling of the most informative areas. He also has to perform a precise histopathological analysis, including the determination of the circumferential margin or clearance and the evaluation of tumor regression. All these parameters are major prognostic factors which have to be clearly included in the pathology report. Moreover, the next challenge for the pathologist will be to determine and validate new prognostic and predictive markers, notably by using pre-therapeutic biopsies. The goal of this mini-review is to emphasize the pathologist's role in the different steps of the management of locally advanced rectal cancers and to underline its implication in the determination of potential biomarkers of aggressiveness and response.
