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How Many Nodes Have to Be Detected/Examined After Preoperative Radio(chemo) Therapy?

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Multidisciplinary Management of Rectal Cancer

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Abstract

In patients with colonic and rectal cancer treated with surgery alone, prognosis depends primarily on the pathological stage of the tumour according to the tumour, node, metastasis (TNM) system, based on the extent of the primary tumour (pT) and its relationship to the muscularis propria, the absence or extent of nodal involvement (pN), the number of the involved regional lymph nodes (pN1 vs. pN2) and the presence or absence of distant metastases (M). It remains uncertain, how best to interpret histopathology for patients with rectal cancer after chemoradiation (CRT) or short-course preoperative radiotherapy (SCPRT). Early histopathological endpoints are dependent on many patient and treatment factors. The number of lymph nodes reported may reflect factors such as quality of TME surgery, whether a high tie was performed, the radiation dose and field size, the type and dose of chemotherapy used, the diligence of the pathologist in processing the specimen and finding lymph nodes, the timing of surgery following CRT or SCPRT and possibly also the route by which these changes were achieved, i.e. chemotherapy, chemoradiation or radiotherapy alone. In this chapter, we will discuss how many nodes are required to be detected and examined after preoperative radio(chemo)therapy to give an accurate prognosis and how increased numbers may be detected in the histopathological specimen.

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Authors and Affiliations

  1. Department of Radiation Oncology, National Cancer Centre, Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    David Tan

  2. Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Iris D. Nagtegaal

  3. Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK

    Rob Glynne-Jones

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  1. David Tan
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  2. Iris D. Nagtegaal
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  3. Rob Glynne-Jones
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Correspondence to Rob Glynne-Jones .

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Editors and Affiliations

  1. Dept. of Radiation Oncology, Università Cattolica S Cuore, Rome, Italy

    Vincenzo Valentini

  2. Head, Div. Clinical Oncology Research, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Department of Surgery, Leiden Univ Med Ctr, Leiden, The Netherlands

    Cornelis J. H. van de Velde

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Tan, D., Nagtegaal, I.D., Glynne-Jones, R. (2018). How Many Nodes Have to Be Detected/Examined After Preoperative Radio(chemo) Therapy?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_65

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  • DOI: https://doi.org/10.1007/978-3-319-43217-5_65

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43215-1

  • Online ISBN: 978-3-319-43217-5

  • eBook Packages: MedicineMedicine (R0)

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