Training activity information
Details
Dissect a range of gastrointestinal specimens received for colorectal cancer:
- Right hemicolectomy
- Colectomy
- Anterior resection
- Polyp
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Considerations
- Local SOPs
- Specimen preparation, orientation, inking, block sampling and macroscopic description
- Quality of blocks
- RCPath cancer datasets
- Macroscopic pathological features specific to the disease entity
- Bowel cancer screening programme
- NICE guidance
- Molecular testing strategies and national guidance
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What are the key anatomical landmarks and structures to identify in each type of resection?
- What do you aim to achieve in terms of accurately assessing tumour extent, lymph node involvement, and other relevant pathological features?
- Discuss the different types of colorectal cancer resections and the specific dissection protocols for each with your training officer.
- Review relevant guidelines and local laboratory policies for dissecting colorectal cancer specimens, including lymph node retrieval and margin assessment.
- What is the significance of different macroscopic features (e.g., tumour size, location, serosal involvement) in colorectal cancer?
- Consider the specific insights you hope to gain regarding the macroscopic appearance of colorectal cancer in different parts of the bowel and the patterns of spread.
- Think about what you already know about gastrointestinal anatomy and how this will inform your dissection.
- What specific skills in handling large resection specimens, identifying key anatomical structures, and sampling appropriate blocks do you hope to develop?
- Discuss this training activity with your training officer to clarify the expected dissection techniques and the rationale for block selection in different colorectal cancer resections.
- Consider potential challenges such as distorted anatomy due to surgery or large tumour size, and how you might approach these.
- Reflect on your current level of confidence in dissecting gastrointestinal specimens and identify any areas where you feel you need to focus your attention.
In action
- How are you approaching the opening and examination of the different types of colorectal resections? Why are you following this particular sequence of steps?
- What decisions are you making about sampling the tumour, margins, lymph nodes, and other relevant areas? What is guiding your choices regarding the size and location of blocks?
- How intuitive does the process of identifying different parts of the colon and mesentery feel? What aspects of assessing polyp morphology or tumour invasion are requiring more deliberate thought?
- How effectively are you demonstrating the relationship between the macroscopic features of the tumour (e.g., size, location, growth pattern) and the surrounding tissue? Are there any unexpected findings during dissection?
- What are you learning in real-time about the variations in surgical resection and tumour presentation in colorectal cancer? How does this relate to your understanding of colorectal pathology?
- Are there alternative dissection techniques you could employ to better evaluate the extent of disease or lymph node involvement? Would discussing your approach with a colleague be beneficial at this stage?
- Are you ensuring that your dissection and sampling are in line with local protocols and best practices for colorectal cancer specimens?
On action
- What were the key macroscopic features of the different colorectal specimens you dissected (right hemicolectomy, colectomy, anterior resection, polyp)?
- How did the location and type of colorectal cancer influence the macroscopic appearance of the specimens?
- What specific approaches did you take for dissecting each type of specimen to identify key features such as tumour extent, lymph nodes, and margins?
- How did the clinical information and request form guide your dissection strategy?
- What challenges did you face during the dissection of these gastrointestinal specimens?
- What did you learn about the critical steps in dissecting colorectal cancer specimens to provide essential diagnostic and prognostic information?
- How did your understanding of colorectal anatomy and cancer pathology improve through this activity? How will this experience impact your future dissection of colorectal specimens?
- What specific dissection techniques for colorectal specimens do you need to practice further?
- How will you ensure you are consistently identifying and sampling relevant lymph nodes and margins?
- Do you need to review any specific guidelines or protocols for colorectal cancer dissection?
Beyond action
- How does your experience of dissecting colorectal specimens compare with dissecting specimens from other organ systems? What similarities and differences in approach did you find, and what have you learned from these comparisons?
- Revisit your reflections from dissecting various colorectal specimens as part of a review of the module and identify any specific learning points or actions you will take forward.
- How has the experience of dissecting colorectal specimens influenced your understanding of tumour staging and its importance for patient management? How have you applied this understanding to subsequent activities?
- Consider how your learning from this DTA will help you when you attend multidisciplinary team (MDT) meetings dealing with colorectal cancer cases.
- What are your clear actions for continued development in the dissection and handling of colorectal specimens?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Dissect the most common malignant specimens from a range of organ systems. |
| # 3 |
Outcome
Employ the appropriate specimen preparation, orientation, inking, block sampling and dissection rationale based on the clinical history for malignant specimens. |
| # 5 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |