Journal of Blood & Lymph

Rectal Cancer and Invasion of Veins: Importance in TNM Staging 2

Abstract

Kiss Lorant, Kiss Roland, Milcioiu Denisa

Summary: Accurate information about infiltration of the tumor to the various layers of the rectal wall is important.
Material and methods: A histopathological study of surgical specimens from 351 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52%.
Results: Follow-up studies showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present.
Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thick–walled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick–walled extramural veins, had greatest adverse influence of all.
Venous spread of tumor takes place in parallel with local spread as measured by the Dukes’ stage but exerts an influence on prognosis independent of the Dukes’ stage.
Similarly, veins invasion parallels the number of lymph nodes metastases but appears to exert an independent influence on prognosis.
Conclusion: The venous spread provides a precise assessment of the likely behavior of rectal cancer, but does not replace indices such as the Dukes’ stage, or the number of lymph nodes metastases in use.