Tumor Deposits in Cancer Colon
Tumor Deposits in Cancer Colon
1. Assessment of correlation between tumor deposits and clinicopathological characteristics
 of colorectal cancer.

 2. Detection of association between tumor deposits and stage of colorectal cancer.

 3. Evaluate the relationship between tumor deposits and prognosis of colorectal cancer
 patient.
Colorectal cancer remains the third most common cancer and the third leading cause of
 cancer-related deaths. For colon cancer alone, 101,220 new cases were projected to occur in
 2019, causing51,020 deaths.

 A number of risk factors have been identified that influence susceptibility to colorectal
 cancer, including a family history, the presence of adenomatous polyps, inflammatory bowel
 disease (ulcerative colitis or Crohn's disease), and number of environmental factors of which
 diet is the most significant.

 CRC differs from many other cancers in that diagnosis of the disease can be made earlier by
 screening techniques including colonoscopy. The progression of CRC is well established and
 begins with hyperproliferation of the colonic mucosa and adenoma formation and then
 adenocarcinomas that vary in metastatic potential.

 The progression from normal intestinal epithelium to an invasive carcinoma is estimated to
 take 7-12 years. With the advent of early screening measures developed over the last few
 decades, CRC has become a preventable disease by treating patients with adenomatous polyps.
 Nearly 50% of patients diagnosed with CRC develop metastasis within five years. Most commonly
 these tumors metastasize to the liver and lungs but may be discovered in many other sites.

 Despite significant improvements in both prevention and screening over the last twenty years,
 about 36,500 (36%) of such cases are still being diagnosed in stage III, with regional lymph
 node involvement (LN+, N1a-b, N2a-b) or tumor deposits (TD+, N1c).

 Tumor deposits (TDs) or mesenteric tumor satellites were firs described in rectal carcinoma
 by Gabriel et al at St. Mark's Hospital in 1935. Subsequently, TDs have been detected in
 various malignancies other than colorectal carcinoma, including gastric, pancreatic,
 gallbladder, and bile duct carcinomas . Over the years, there is much debate about the
 genesis, histopathologic characteristics, and prognostic value of TDs.

 TDs are associated with advanced colorectal carcinoma stage and poor prognosis, with variable
 outcome due to different definitions of TDs.

 Before the 5th edition, published in 1997, TNM classification did not consider microscopic
 TDs to be lymph node metastases (LNMs), and they classified them as discontinuous extension
 in the T category .

 In the 5th TNM edition the 3-mm rule was introduced, which stated that TDs >3mm in diameter
 were LNMs .

 In the 6th edition published in 2002, TDs were classified based on the contour of the
 deposit. A TD with a smooth contour was considered as LMN, whereas a TD with an irregular
 contour was considered as venous invasion (V1/2) or lymphatic invasion (L1).

 The 8th TNM Edition clarified that the presence of TDs does not change the primary tumor T
 category, but changes the node status (N) to pN1c if all regional lymph nodes are negative on
 pathological examination.

 In studies of rectal cancer patients, it should be taken into account that TDs may indicate
 microscopic residuals of the main tumor after neoadjuvant chemo radiation and not
 discontinuous foci of tumor as indicated in the classic definition of TDs.

 The presence of TDs was an independent adverse prognostic factor that was significantly
 associated with shorter disease-free survival independent of lymph node status in stage IV
 colorectal cancer patients who underwent simultaneous resection for synchronous colorectal
 liver metastases.

 After chemo-radiotherapy, rectal cancer is usually associated with small clusters of tumor
 cells or isolated tumor cells, scattered within or outside the rectal wall which are often
 associated to fibrosis and chronic inflammation, as well as other radiation induced changes.
 The prognostic significance of TDs in rectal adenocarcinoma following neoadjuvant
 chemoradiation has not yet been determined, although this remains an important issue given
 that patients who receive neoadjuvant chemoradiation have more advanced tumors and the
 highest risk of distant and local recurrences.

 TDs were associated with higher rates of lymph node involvement, distant metastases and
 reduced survival; more over TDs are associated with aggressive characteristics, including
 higher rates of positive circumferential resection margins.
Inclusion Criteria:

 - 1-This retrospective study includes primary invasive colorectal carcinoma samples from
 Egyptian patients.

 2-Patients who underwent resection of colorectal cancer will be included in our study.

 Exclusion Criteria:

 -  1-All patients who underwent endoscopic biopsies