Perforation

— present/absent. Perforation has a higher incidence of local recurrence and poorer prognosis. Perforation through the tumour is TNM stage pT4 because of the potential contact with peritoneum. This does not include proximal ischaemic back-pressure perforation (e.g. caecum) due to an obstructing distal cancer. In this case the pT stage is determined by the degree of local spread of the distal cancer.

A Retroperitoneal (posterior) surface

Figure 5.1. Extent of serosal covering of the large intestine. Arrows indicate the "bare" non-peritonealized areas of different levels. A. The ascending and descending colon are devoid of peritoneum on their posterior surface. B. The sigmoid colon is completely covered with peritoneum, which extends over the mesentery. C. The lower rectum lies beneath the pelvic peritoneal reflection. The asterisks in A indicate the sites where serosal involvement by tumour is likely to occur. (Reproduced with permission from Burroughs SH, Williams GT. ACP best practice no. 159. Examination of large-intestine resection specimens. J Clin Pathol 2000;53:345, reproduced with permission from the BMJ Publishing Group.)

Figure 5.1. Extent of serosal covering of the large intestine. Arrows indicate the "bare" non-peritonealized areas of different levels. A. The ascending and descending colon are devoid of peritoneum on their posterior surface. B. The sigmoid colon is completely covered with peritoneum, which extends over the mesentery. C. The lower rectum lies beneath the pelvic peritoneal reflection. The asterisks in A indicate the sites where serosal involvement by tumour is likely to occur. (Reproduced with permission from Burroughs SH, Williams GT. ACP best practice no. 159. Examination of large-intestine resection specimens. J Clin Pathol 2000;53:345, reproduced with permission from the BMJ Publishing Group.)

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