The surgical pathology of rectal cancer

N English visitor to the United States A of America is bound to be overwhelmed at first by the realization of what a lot the OId World has to learn from the New, especiahy in the organization and application of scientific knowledge. I have been very conscious of this when studying the organization of pathoIogic services in your hospitals \vhich fill me with admiration and envy. Even in the specia1 subject on which this article is based, I know ful1 well that I have learned much in the past and am still learning from American pathologists and surgeons. At the same time I venture to think that 1 have something to give in return because for twenty-live years I have been in charge of the Department of Pathology at St. Mark’s Hospital, London, a special hospital for the treatment of diseases of the rectum and coIon. Soon after I was appointed pathoIogist to this hospital in rg23 I developed a method of examining specimens of intestinal cancer so as to learn as much as possible in each case about the origin, structure and spread of the tumor. I have been fortunate in having been able to continue this work without interruption over a long period, so that in more than 3,000 cases full detaiIs are now available as to the size and position of the primary tumor, the extent of local and venous spread, and the exact number, size and position of a11 Iymphatic metastases. This experience has Ied us at St. Marks to adopt a threefoId cIassification of intestinal cancer based on the gross characteristics, histology and extent of spread of the tumor. This has proved to be of special value from the point of view of prognosis after surgical treatment.