Colorectal cancer (staging)

Changed by Robert Hodnett, 19 Nov 2017

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Colorectal carcinoma staging can be performed using two systems. The traditional Dukes staging system has largely been replaced by the TNM system, but is nonetheless often used clinically.

Staging

Dukes (Astler-Coller modification)

stage A: confined to mucosa
stage B: through muscularis propria
stage C: local lymph node involvement
stage D: distant metastases

TNM staging

Primary tumour staging (T)

Tx: primary tumour cannot be assessed
T0: no evidence of primary tumour
Tis: carcinoma in situ
T1: into (but not through) submucosa
T2: into (but not through) muscularis propria
T3
- through muscularis propria into subserosa, or
- into non-peritonealised pericolic/perirectal tissues
T4a: penetration of the visceral peritoneal layer
T4b: penetration or adhesion to adjacent organs

Nodal status (N)

Nx: nodes cannot be assessed
N0: no evidence of nodal involvement
N1a: involvement of one regional nodes
N1b: involvement of 2-3 regional nodes
N1c: ~~involvement of~~ deposits involving serosa or non-peritonealised pericolic/perirectal tissues without regional nodal metastasis
N2a: involvement of 4-6 nodes
N2b: involvement of ≥7 mode

Metastases (M)

Mx: presence of metastases cannot be assessed
M0: no evidence of metastases
M1a: distant metastases confined to one organ (e.g. liver, lung, ovary, non-regional node)
~~M2b~~M1b: distant metastases confined to more than one organ or to the peritoneum

~~-N1c: involvement of serosa or non-peritonealised pericolic/perirectal tissues without regional nodal metastasis</li>~~
+N1c: deposits involving serosa or non-peritonealised pericolic/perirectal tissues without regional nodal metastasis</li>
~~-M2b: distant metastases confined to more than one organ or to the peritoneum</li>~~
+M1b: distant metastases confined to more than one organ or to the peritoneum</li>