Revision 28 for 'Rectal cancer (staging)'

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Rectal cancer staging

Staging strongly influences the success of, and rate of local recurrence following rectal cancer resection.

TNM staging

See : TNM staging system for a general description.

Primary tumor staging (T)
  • Tx - primary tumor cannot be assessed
  • T0 - no evidence of primary tumor
  • Tis - carcinoma in situ: intraepithelial or invasion of lamina propria
  • T1 - tumor invades submucosa
  • T2 - tumor invades muscularis propria
  • T3 - tumor invades through the muscularis propria into the subserosa or into non-peritonealised peri-rectal tissues
    • T3a - tumor extends < 1mm beyond muscularis propria 4
    • T3b - tumor extends 1-5 mm beyond muscularis propria 4
    • T3c - tumor extends 5-15 mm beyond muscularis propria 4
    • T3d - tumor extends 15 mm beyond muscularis propria 4
  • T4 - tumor invades directly into other organs or structures and/or perforates visceral peritoneum
    • T4a - tumor penetrates to the surface of the visceral peritoneum
    • T4b - tumor directly invades or is adherent to other organs or structures
Regional lymph nodes (N)

The size cut off for mesorectal nodes is usually taken at 5mm 6

  • Nx - regional nodes not assessed
  • N0 - no regional lymph nodes
  • N1 - metastasis in 1-3 regional (peri-rectal) lymph nodes
    •  
    • N1a  - metastasis in one regional lymph node
    • N1b  - metastasis in 2–3 regional lymph nodes
    • N1c - tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal  tissues without regional nodal metastasis
  • N2 - metastasis in 4 or more regional lymph nodes
    •  
    • N2a - metastasis in 4–6 regional lymph nodes
    • N2b - metastasis in 7 or more regional lymph nodes
  • Mx : cannot be assessed
  • M0 : no distant metastasis
  • M1 : distant metastasis
    • M1a  - metastasis confined to one organ or site (for example, liver, lung, ovary, nonregional node)
    • M1b - metastases in more than one organ/site or the peritoneum

Stage groupings

  • stage 0 - Tis N0 M0
  • stage I - T1-2, N0 M0
  • stage II
    • IIa - T3, N0, M0
    • IIb - T4a, N0, M0
    • IIc - T4b, No, Mo
  • stage III
    • IIIa - T1-2, N1, M0
    • IIIb - T3-4, N1, M0
    • IIIc - T3-4b, N2, M0
  • stage IV - any T, any N M1

See also

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