Colon cancer staging
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Colon cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel mo ...
staging is an estimate of the amount of penetration of a particular cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers depend on the extent of local invasion, the degree of lymph node involvement and whether there is distant metastasis. Definitive staging can only be done after
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
and histopathology of colorectal carcinoma. An exception to this principle would be after a colonoscopic polypectomy of a malignant pedunculated polyp with minimal invasion. Preoperative staging of rectal cancers may be done with endoscopic ultrasound. Adjunct staging of metastasis include abdominal ultrasound, MRI, CT, PET scanning, and other imaging studies.


TNM staging system

The most common staging system is the TNM (for tumors/nodes/metastases) system, from the American Joint Committee on Cancer. This system assigns a number based on three categories. "T" denotes the degree of invasion of the intestinal wall, "N" the degree of lymphatic node involvement, and "M" the degree of metastasis. Possibly, the overall Joint Committee stage is a shorter format of the TNM stage, and is usually quoted as a number I, II, III, IV derived from the TNM value grouped by prognosis; a higher number indicates a more advanced cancer and likely a worse outcome. Following is the eighth edition from 2017:


Tumor (T)

Numbers 0 to 4, with subgroups, are used to describe deepest tumor depth: Approved by the Cancer.Net Editorial Board, 11/2018. In turn citing:
*TX: The primary tumor cannot be evaluated. *T0: No evidence of cancer in the colon or rectum. *Tis: Carcinoma ''in situ''; Cancer cells are found only in the
epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...
or
lamina propria The lamina propria is a thin layer of connective tissue that forms part of the moist linings known as mucous membranes or mucosae, which line various tubes in the body, such as the respiratory tract, the gastrointestinal tract, and the urogenita ...
*T1: Growth into the
submucosa The submucosa (or tela submucosa) is a thin layer of tissue (biology), tissue in various organ (anatomy), organs of the gastrointestinal tract, gastrointestinal, respiratory tract, respiratory, and genitourinary system, genitourinary tracts. It i ...
*T2: Growth into the
muscularis propria The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
*T3: Growth through the muscularis propria and into the subserosa, or into tissues surrounding the colon or rectum (but not the visceral peritoneum or surrounding organs). *T4a: Growth into the surface of the visceral peritoneum. *T4b: The tumor has grown into or has attached to other organs or structures.


Node (N)

Numbers 0 to 2, and subgroups, are used to describe lymph node involvement: *NX: The regional lymph nodes cannot be evaluated. *N0: No evidence of spread to regional lymph nodes. *N1a: Tumor cells found in 1 regional lymph node. *N1b: Tumor cells found in 2 or 3 regional lymph nodes. *N1c: There are cancerous nodules near the colon that do not appear to be lymph nodes. *N2a: Tumor cells found in 4 to 6 regional lymph nodes. *N2b: Tumor cells found in 7 or more regional lymph nodes.


Metastasis (M)

Numbers 0 and 1, with subgroups, describe the metastasis status: *M0: No evidence of distant metastasis *M1a: Spread to 1 other part of the body beyond the colon, rectum or regional lymph nodes. *M1b: Spread to more than 1 part of the body other than the colon, rectum or regional lymph nodes. *M1c: Spread to the peritoneal surface.


Overall AJCC stage


Dukes classification

In 1932 the British pathologist
Cuthbert Dukes Cuthbert Esquire Dukes OBE (24 July 1890 – 3 February 1977) was an English physician, pathologist and author, for whom the Dukes classification for colorectal cancer is named. Career Dukes was educated at Caterham School. He graduated with a ...
(1890–1977) devised a
classification Classification is a process related to categorization, the process in which ideas and objects are recognized, differentiated and understood. Classification is the grouping of related facts into classes. It may also refer to: Business, organizat ...
system for
colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel m ...
. Several different forms of the Dukes classification were developed. However, this system has largely been replaced by the more detailed TNM staging system and is no longer recommended for use in clinical practice. * Dukes A: Invasion into but not through the bowel wall * Dukes B: Invasion through the bowel wall penetrating the muscle layer but not involving lymph nodes * Dukes C: Involvement of lymph nodes * Dukes D: Widespread metastases


Astler-Coller classification

An adaptation by the Americans Astler and Coller in 1954 further divided stages B and C * Stage A: Limited to
mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
* Stage B1: Extending into
muscularis propria The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
but not penetrating through it; nodes not involved * Stage B2: Penetrating through muscularis propria; nodes not involved * Stage B3: Invading into adjacent organs/structures; nodes not involved * Stage C1: Extending into muscularis propria but not penetrating through it. Nodes involved * Stage C2: Penetrating through muscularis propria. Nodes involved * Stage D: Distant metastatic spread The stage gives valuable information for the
prognosis Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...
and management of the particular cancer.


Full Dukes classification

Another modification of the original Dukes classification was made in 1935 by Gabriel, Dukes and Bussey. This subdivided stage C. This staging system was noted to be prognostically relevant to rectal and colonic adenocarcinoma. Stage D was added by Turnbull to denote the presence of liver and other distant metastasesTurnbull RB Jr, Kyle K, Watson FR, et al: Cancer of the colon: the influence of the no touch isolation technique on survival rates. Ann Surg 166:420-7, 1967 * Stage A: Limited to
muscularis propria The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
; nodes not involved * Stage B: Extending beyond
muscularis propria The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
; nodes not involved * Stage C: Nodes involved but highest (apical) node spared * Stage D: Distant metastatic spread File:Diagram showing Dukes A bowel cancer CRUK 116.svg, Dukes stage A bowel cancer; the cancer is only in the inner lining of the bowel. File:Diagram showing Dukes' B bowel cancer CRUK 117.svg, Dukes stage B bowel cancer; the cancer has invaded the muscle. File:Diagram showing Dukes' C bowel cancer CRUK 118.svg, Dukes stage C bowel cancer; the cancer has invaded the nearby lymph nodes. File:Diagram showing Dukes' D bowel cancer CRUK 119.svg, Dukes stage D bowel cancer; the cancer has metastasized.


References

{{reflist Cancer staging zh:大腸癌#分期