Measuring the Depth of Invasion in Submucosal(SM)Cancer of the Colon and Rectum Based on the Guidelines for the Treatment of Colon and Rectal Cancer and Its Supplementary Notes Natsuko Saito 1 , Takahiro Fujimori 1 , Shigehiko Fujii 1 , Kazuhito Ichikawa 1 , Motohiko Hirose 1 , Hiroyuki Tanaka 1 , Mio Katano 1 , Yukari Fujimori 1 , Toshio Tanaka 2 , Nozomu Kobayashi 3 , Hiroaki Ikematsu 4 , Takayuki Yoshino 4 , Yosuke Ootake 5 , Takahisa Matsuda 5 , Yoshinori Katake 1 , Hideo Ogata 1 , Yuko Kawase 1 , Hidetsugu Yamagishi 1 , Katsumasa Suzuki 1 , Akira Sekikawa 1 , Hirokazu Fukui 1 , Shigeki Tomita 1 , Joji Imura 1 , Hideaki Sato 1 1Department of Molecular and Surgical Pathology, Dokkyo Medical University of Medicine, Shimotsuga, Japan 2Department of Gastroenterology, Shizuoka City Hospital, Shizuoka, Japan 3Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan 4Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan 5Endoscopy Division, National Cancer Center Hospital, Tokyo Keyword: 大腸SM癌 , 浸潤距離 , 脈管侵襲 , head invasion , 簇出 pp.1219-1228
Published Date 2009/7/25
DOI https://doi.org/10.11477/mf.1403101717
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 We outline the method for measuring the depth of invasion in submucosal(SM)cancer of the colon and rectum based on the Guidelines for the Treatment of Colon and Rectal Cancer. Additionally, we indicate several points to be corrected and refer to supplementary notes and improvements for making it possible for gastrointestinal endoscopists and surgeons to use the method. Any subclassification of SM cancer has exceptional cases. So, we aim not to compete in the classification of SM cancer but to discover a standardized rate of lymph node metastasis. In the future, diagnosis and the selection of endoscopic treatment may be made based on genetic abnormalities, or epigenetic factors. However, we emphasize that it is now most important to improve the diagnostic accuracy of the horizontal margin(pHM), vertical margin(pVM), depth of invasion(1,000μm, or not), invasion of vessels, and budding/sprouting of samples obtained during endoscopic treatment. Particularly we discuss the importance of assessing whether the lesion is pedunculated in order to treat it endoscopically and the need to give directions to widely adapt head invasion in pedunculated lesions.

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