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  • Colorectal cancer with direct invasion of adjacent organs or structures and/or perforation of the visceral peritoneum. Direct invasion in T4 includes invasion of other segments of the colorectum by way of the serosa. Invasion of the sigmoid colon by a carcinoma of the cecum, for example, should be classified as T4. Tumor that is adherent to other organs or structures macroscopically is classified as T4. However, if on microscopic examination, no tumor is present in the adhesion, the classification should be pT3. V and L substaging should be used to indicate the presence or absence of vascular or lymphatic invasion. (from AJCC 6th Ed.)
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