**2. Correlations between lymph node metastasis and early colorectal carcinoma**

The endoscopic mucosal resection and endoscopic submucosal dissection (EMR/ESD) have become useful for early CRC which is defined as a T1 stage tumour whose invasion is limit‐ ed to the mucosa or submucosa according to the T categories for colorectal cancer of the American Joint Committee on Cancer (AJCC) staging system (Table 1).

**3. Ip type (pedunculated lesion) and non-Ip type (nonpedunculated**

Macroscopic type (endoscopic finding) was assessed according to the macroscopic clas‐ sification of early stomach carcinoma, with minor modifications. In shortly, SICCs were div‐ ided into two lesions: pedunculated (Ip type) (Figure. 1, Figure. 2(a)) and nonpedunculated (Non-Ip type) (Figure. 1b, Figure. 2(b)). Nonpedunculated lesion were subclassified as semi‐ pedunculated lesion (Isp type) and sessile lesion (Is type). Respectively. Ip type (pedunculat‐

Desmoplastic Reaction in Biopsy Specimens of T1 Stage Colorectal Cancer Plays a Critical Role in Defining the Level...

http://dx.doi.org/10.5772/51900

163

**Figure 1.** Schema of macroscopic (endoscopic) classification of SICCs: pedunculated(Ip type) and nonpedunculat‐

(a) (b)

**Figure 2.** Histological appearance of pedunculated(Ip type) (a) and nonpedunculated(Non-Ip type) (b) on Hematoxy‐

**lesion) of early colorectal carcinoma**

ed(Non-Ip type). Arrowhead: muscularis mucosae.: 0 µm

lin and Eosin staining section.

ed lesion) has typically head with stalk (Figure. 1, Figure 2).

Tx: No description of the tumor's extent is possible because of incomplete information.

Tis: The cancer is in the earliest stage (in situ). It involves only the mucosa. It has not grown beyond the muscularis mucosa (inner muscle layer).

T1: The cancer has grown through the muscularis mucosa and extends into the submucosa.

T2: The cancer has grown through the submucosa and extends into the muscularis propria (thick outer muscle layer).

T3: The cancer has grown through the muscularis propria and into the outermost layers of the colon or rectum but not through them. It has not reached any nearby organs or tissues.

T4a: The cancer has grown through the serosa (also known as the visceral peritoneum), the outermost lining of the intestines.

T4b:The cancer has grown through the wall of the colon or rectum and is attached to or invades into nearby tissues or organs.

**Table 1.** T categories for colorectal cancer of the AJCC staging system.

The endoscopic mucosal dissection (EMR: endoscopic mucosal resection and ESD: endo‐ scopic submucosal dissection) of intramucosal carcinoma is accepted as curative, as there is almost negative of lymph node metastasis. [1-4]. However, the reported prevalence rates of lymph node metastasis range from 6 to 12% of all patients with submucosal invasive color‐ ectal carcinoma (SICC) [3-6]. Therefore, the endoscopic mucosal dissected cases of SICC with lymph node metastasis, and after EMR/ESD, surgical resection accompanied with lymph node dissection is necessary.

It has been known that we should be considered be additional resection is required due to the risk of lymph node metastasis following findings (1) massive submucosal invasion: (2) lymphatic/vessel invasion; or (3) poorly differentiated component in resected EMR/ESD specimens [7, 8]. There has been no standard method of measurement of sub‐ mucosal invasion depth. Therefore, Japanese Society for Cancer of the Colon and Rectum has recently demonstrated definite for method of measurement of submucosal invasion depth.
