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Gut 51:6-7 doi:10.1136/gut.51.1.6
  • Commentary

A long hard look at Dukes' B

  1. G T Williams
  1. Department of Pathology, University of Wales College of Medicine, Cardiff, CF14 4XN; williamsgt@cf.ac.uk

    Identification of prognostic pathological factors in Dukes' B colon cancer

    Carcinoma of the colon is somewhat of a Cinderella among colorectal cancers, and during the last few years its ugly sister, carcinoma of the rectum, has hogged the limelight. This has been largely due to the (deserved) attention that has been paid to reducing local recurrence in rectal cancer through better preoperative imaging, surgical technique, and adjuvant chemoradiotherapy. However, cancer of the colon remains a highly lethal tumour. There is little controversy that it is best treated initially by surgical resection, that patients with completely resected Dukes' A tumours of usual histological type require no more treatment, and that patients found to have Dukes' C tumours after histological examination of the resection specimen should be offered adjuvant chemotherapy.1 For the 40% or so of colonic cancers that are Dukes' B, however, there is great uncertainty surrounding the place of such chemotherapy, as has been highlighted in the recently published revised Guidelines for the management of colorectal cancer (2001) from the Association of Coloproctology of Great Britain and Ireland (ACP).2 Part of the reason for this is that the Dukes' B category encompasses a wide range of tumours, from those that have just penetrated the muscular coat of the bowel wall to widely infiltrative neoplasms that show extensive extramural local spread, and it would not be surprising that the benefit of postoperative chemotherapy might vary in parallel with this. …