Revision 18 for 'Colorectal cancer (staging)'

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Colorectal cancer staging

There are two main colorectal carcinoma staging schemes. The traditional Duke's has largely been replaced by the TNM system, but is nonetheless often used clinically.


Duke's (Astler-Coller modification)
  • stage A: confined to mucosa
  • stage B: though muscularis propria
  • stage C: local lymph node involvement
  • stage D: distant metastases
TNM staging
Primary tumor staging (T)
  • Tx: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • 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-peritonealized pericolic/perirectal tissues
  • T4: direct extension into adjacent organs
Nodal status (N)
  • Nx: nodes cannot be assessed
  • N0: no evidence of nodal involvement
  • N1: involvement of 1 to 3 regional nodes
  • N2: involvement of 4 or more nodes
Metastases (M)
  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

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