# Micropapillary adenocarcinoma of the colon and rectum

Source: https://onco.cc/cancers/colorectal-micropapillary-carcinoma/  
OnCo record `colorectal-micropapillary-carcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Micropapillary adenocarcinoma is bowel cancer in which some of the tumour grows as tiny clusters of cells floating in empty spaces, with the cells turned inside out so the surface that normally faces the bowel faces outwards instead. It is a pattern that goes with heavier invasion of lymph and blood vessels and more involved lymph nodes, and it is graded and treated like ordinary bowel cancer.

## Summary

What it is. The 2019 World Health Organization classification of digestive tumours lists micropapillary adenocarcinoma among the histological subtypes of colorectal adenocarcinoma (Nagtegaal 2020). Under the microscope the tumour forms small morula-like nests of cells without a fibrovascular core, sitting in empty lacunar spaces, and the cells show reversed polarity: the apical membrane faces the stroma rather than a lumen, which can be shown by staining for villin or epithelial membrane antigen (Oncol Lett 2021).

How it differs from its parent. The micropapillary component is almost never the whole tumour. Reported proportions range from 5 to 80 percent of a lesion and are usually under 30 percent (J Gastrointest Cancer 2026). Where it is present, tumours show more lymphatic and vascular invasion, a higher ratio of involved to examined lymph nodes and a higher pathological T category than colorectal cancers without it, and more invasion again as the proportion rises (Hum Pathol 2018). KRAS, BRAF and TP53 mutations are described in the pattern and are read as driving invasiveness and the loss of polarity rather than defining a separate disease (J Gastrointest Cancer 2026).

How common it is. In 266 colorectal cancers the pattern was found in 27.8 percent at any extent and in 9.4 percent at 5 percent or more of the tumour (Hum Pathol 2018); in 453 tumours the 5 percent threshold was met in 19.8 percent (Oncol Lett 2021). Counts depend entirely on the threshold used, and no national registry records it.

How it is treated. No trial has been run in this histology. Treated as colorectal adenocarcinoma: resection with adjuvant chemotherapy by stage when removable, the systemic rows of the parent page when not; the parent record carries the trials. The practical consequence of the report is staging: the pattern travels with node involvement, so it is a reason to look carefully at the nodes and the margins rather than a reason to change the drugs.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Micropapillary adenocarcinoma of the colon and rectum (small tumour nests with reversed polarity; heavy lymphatic and vascular invasion); Colorectal micropapillary carcinoma; Micropapillary colorectal cancer; Colorectal carcinoma with micropapillary pattern
- Tags: gi; colorectal; subtype-page
- Group: gastrointestinal
- Burden: A pattern rather than a separate tumour in most series. In 266 Korean colorectal cancers a micropapillary pattern of any extent was present in 27.8 percent and made up 5 percent or more of the tumour in 9.4 percent; in a later series of 453 tumours the 5 percent threshold was met in 19.8 percent. No UK or registry count is published.
- Subtypes: Colorectal adenocarcinoma with a focal micropapillary component (under 5 percent of the tumour); Colorectal adenocarcinoma with a substantial micropapillary component (5 percent or more, the threshold most series use); Micropapillary pattern arising within mucin pools (distinguished from pure micropapillary pattern)
- Biomarkers: Micropapillary component as a percentage of the tumour, recorded in the pathology report; Reversed polarity shown by villin, epithelial membrane antigen or E-cadherin staining; Lymphatic and vascular invasion, which travel with the pattern

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/colorectal-micropapillary-carcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#what-it-is [3 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#finding-it [3 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#treating-it [1 setting, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#evidence
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#science
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/#living-with-it [8 questions, 2 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/coming/ [2 medicines]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/colorectal-micropapillary-carcinoma/data/ [10 connected records]

## Standard of care

- Localised disease: Resection with the usual nodal harvest; adjuvant chemotherapy decided by stage as for colorectal adenocarcinoma of no special type, with the node involvement that travels with this pattern taken into account. ([Colectomy](https://onco.cc/terms/colectomy/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Colorectal_cancer
- Nagtegaal, Histopathology 2020: the 2019 WHO classification of tumours of the digestive system: https://doi.org/10.1111/his.13975
- Hum Pathol 2018: the clinicopathological significance of micropapillary pattern in colorectal cancers (266 tumours): https://doi.org/10.1016/j.humpath.2018.02.027
- Oncol Lett 2021: villin as a biomarker for reverse polarity in colorectal micropapillary carcinoma (453 tumours): https://doi.org/10.3892/ol.2020.12333
- J Gastrointest Cancer 2026: colorectal micropapillary adenocarcinoma, molecular mechanisms and clinical implications (review): https://doi.org/10.1007/s12029-025-01372-z
- NICE NG151: colorectal cancer, recommendations (Lynch 1.1, local disease 1.3, biomarkers 1.4, metastatic disease 1.5, ongoing care and support including follow-up 1.6): https://www.nice.org.uk/guidance/ng151/chapter/Recommendations

## Connected records

- cancers: [Adenoma-like adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-adenoma-like-adenocarcinoma/), [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Mucinous adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-mucinous-adenocarcinoma/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/), [Serrated adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-serrated-adenocarcinoma/)
- technologies: [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/)
- terms: [Circumferential resection margin (rectal cancer)](https://onco.cc/terms/circumferential-resection-margin/), [Colectomy](https://onco.cc/terms/colectomy/), [Grade](https://onco.cc/terms/tumour-grade/), [TNM staging](https://onco.cc/terms/tnm-staging/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/)
- drugs: [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/)

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JSON: https://onco.cc/api/v1/entities/colorectal-micropapillary-carcinoma.json