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Pathological Evaluation, Classification, and Staging of Gastrointestinal Cancers

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Abstract

Pathological evaluation of tissue with tissue diagnosis is an essential component in the management of gastrointestinal cancer and involves appropriate expertise in ruling out various morphological mimickers ranging from reactive process at one end to benign and malignant tumors at the other. A variety of ancillary tests including immunophenotyping by immunohistochemistry or flow cytometry, fluorescence in situ hybridization/chromogenic in situ hybridization (FISH/CISH), cytogenetics, various molecular tests, electron microscopy, etc., may have to be applied if the morphological features are not sufficient enough to reach definitive interpretation. Pathological evaluation also includes classification, grading, and staging of tumor with additional increasing role of molecular tests. Classifications are generally based on histogenesis (tissue of tumor origin)/differentiation. Some, such as the World Health Organization (WHO) classification, are favored over others. Grading of tumor is an additional component of tissue diagnosis, but may not be significantly important for all tumors. Some specific tumor/organ systems such as neuroendocrine tumors and gastrointestinal stromal tumor have special grading system. Staging is a critical component of pathological evaluation of resection specimens for proper clinical management. The most widely practiced staging system is TNM (Tumor, Node, Metastasis) staging by the American Joint Committee on Cancer (AJCC). Some neoplasms may have modified staging systems.

Keywords

  • Gastrointestinal tract
  • GI cancer
  • Pathological evaluation
  • WHO
  • TNM staging
  • Fine-needle aspiration
  • FNA
  • Biopsy
  • Immunohistochemistry
  • Endoscopy
  • Resection
  • Image guided

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Acknowledgments

The author thanks Paul Tranchida, MD (Cytopath); Hayan Jaratli, MD (Hempath and GI path); Fazlul Sarkar, PhD (Molecular path); and Deepti Munjal, MD (Hem-Onc) for their critical input. Scientific draft editing for improving this chapter by Elly Landolfi, MD (Cytopathology fellow); Anjani Shidham, BS; and Andrea Black, CT (ASCP)CM is greatly appreciated. I also thank Kathy Rost; Yilan Li, MD, PhD (Cytopathology fellow); and Olubunmi Shoyele, MD (Cytopathology fellow) for diligent copy-editing of the page proofs of the final chapter.

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Shidham, V.B. (2019). Pathological Evaluation, Classification, and Staging of Gastrointestinal Cancers. In: Yalcin, S., Philip, P. (eds) Textbook of Gastrointestinal Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-18890-0_2

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