Évaluation de la réponse histologique dans les cancers du rectum localement avancés après traitement néoadjuvant

Locally advanced rectal cancers mainly correspond to lieberkünhian adenocarcinomas and are defined by T3–T4 lesions with or without regional metastatic lymph nodes. Such tumors benefit from neoadjuvant treatment combining chemotherapy and radiotherapy, followed by surgery with total mesorectum excision. Such a strategy can decrease the rate of local relapses and lead to an easier complementary surgery. The pathologist plays an important role in the management of locally advanced rectal cancer. Indeed, he is involved in the gross examination of the mesorectum excision quality and in the exhaustive sampling of the most informative areas. He also has to perform a precise histopathological analysis, including the determination of the circumferential margin or clairance and the evaluation of tumor regression. Indeed this parameter is a major prognostic factor which has to be included in the pathology report. Moreover, the next challenge for the pathologist will be to determine and validate new prognostic and predictive markers, notably by using pre-therapeutic biopsies. The goal of this review is to emphasize the pathologist’s role in the assessment of histologic response of locally advanced rectal cancers after neoadjuvant treatment.     

Prise en charge des cancers du côlon non métastatique chez les patients âgés

Colon cancer occurred mainly in elderly. Improvements have been made in surgery but the indication of chemotherapy remains controversial. The choice of chemotherapy regimen and the selection of the patient to be treated are crucial. Prospective studies specific of elderly are needed.