Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide.  Although the modern approach to patient management takes place in a multidisciplinary setting, pathologists play a central role through the accurate detection and reporting of factors that determine prognosis and dictate the further course of treatment.

The tumor, node, metastasis (TNM) classification system, currently in its 8th edition, is the most widely used staging system in CRC,  but is not always easily translated into daily practice. In our experience, certain issues seem to pose recurring challenges and some updates within the past decade have introduced controversial changes that have not always been adopted in current practice. In addition, a recent survey of US and Canadian pathologists has highlighted significant practice variations in reporting of CRC resection specimens.

Current classification systems do not always account for the varying biological behavior of tumors of the same stage. For instance, patients with stage II tumors may or may not receive adjuvant chemotherapy, depending on the presence or absence of certain prognostic factors. With the expansion of screening colonoscopy programs, the proportion of patients diagnosed with early CRC may increase. Therefore, additional reporting categories that better stratify prognosis in these patients are important. This review addresses new concepts and challenges in the pathologic assessment and reporting of CRC.

Thanks and Regards,
Michelle
Managing Editor
Colorectal Cancer: Open Access