Post-surgical staging following neoadjuvant therapy
A subset of patients with primary rectal cancer may be treated with neoadjuvant radiotherapy or chemoradiotherapy prior to surgical resection of the tumour. The stage given in this situation is an indication of the extent of tumour actually present at the time of examination of the surgical specimen, and is not an estimate of tumour prior to neoadjuvant therapy. Tumour spread is defined by the extent of direct spread of tumour cells. The presence of fibrosis, necrosis or acellular mucin pools should be reported but is not counted in the assessment of extent of tumour spread for staging purposes. The ‘yp’ prefix is used to denote postsurgical TNMA system that describes the amount and spread of cancer in a patient’s body. T describes the size of the tumour and its spread into nearby tissue; N describes the spread to nearby lymph nodes and M describes metastasis (spread of cancer to other parts of the body). stage following neoadjuvant therapy.