Prognostic markers in colorectal pathology: is morphology enough?

Colorectal cancer is the second commonest cause of cancer-related death after lung cancer. Adjuvant chemotherapy has become the standard of care for patients with stage III colon cancer. However, there is a need for better risk stratification in stage II disease where a significant proportion of patients are at risk of disease recurrence and controversy still exists on the role of chemotherapy. This can be achieved by the application of standardized morphological features in a consistent manner, many of which are associated with hazard ratios beyond what can be achieved by new molecular biomarkers. Molecular biomarkers, however, have promise in this setting and may be more precise, with the added advantage of being predictive and thus individualizing therapy.