Revision 19 for 'Colorectal cancer (staging)'

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Colorectal cancer staging

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 The traditional Dukes staging system has largely been replaced by the TNM system, but is nonetheless often used clinically.

Staging

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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