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'''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:mgibson@perfuse.org]  Phone:617-632-7753; Elliot B. Tapper, M.D., Beth Israel Deaconess Medical Center
__NOTOC__
{{Colon cancer}}
{{Colon cancer}}
To view the staging of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis staging|'''here''']]<br>
To view the staging of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer staging|'''here''']]<br><br>
{{CMG}} {{AE}}  Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.


==Overview==
==Overview==
Colorectal cancer staging is an estimate of the amount of penetration of the [[cancer]].  It is performed for diagnostic and research purposes and to determine the optimal method of treatment.  Staging is based on the [[TNM classification|TNM classification system]] which depends on the extent of local invasion, the degree of [[Lymph node metastases|lymph node involvement]], and whether there is distant [[metastasis]]. The staging systems are called Duke's classification, [[TNM classification]], and AJCC stage grouping.


==Staging==
==Colorectal Cancer Staging==
Colon cancer 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 largely depend on the extent of local invasion, the degree of lymph node involvement and whether there is distant [[metastasis]].
*Colorectal cancer staging is an estimate of the amount of penetration of the [[cancer]]
*It is performed for [[diagnostic]] and [[research]] purposes, and to determine the best method of treatment
*The systems for staging colorectal cancers largely depend on the extent of local invasion, the degree of [[Lymph node metastases|lymph node involvement]], and whether there is distant [[metastasis]]
*Definitive staging can only be done after [[Colectomy|surgery]] has been performed and [[pathology]] reports have been reviewed
*An exception to this principle would be after a [[colonoscopic]] [[polypectomy]] of a malignant [[Pedunculated|pedunculated polyp]] with minimal invasion
*Preoperative staging of  may be done with [[endoscopic ultrasound]]
*Adjuncts to staging of metastasis include [[Medical ultrasonography|abdominal ultrasound]], [[Computed tomography|CT]], [[Positron emission tomography|PET scanning]], and other imaging studies


Definitive staging can only be done after [[Colectomy|surgery]] has been performed and  pathology reports reviewed. 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]]. Adjuncts to staging of metastasis include [[Medical ultrasonography|Abdominal Ultrasound]], [[Computed tomography|CT]], [[Positron emission tomography|PET Scanning]], and other imaging studies.
===Dukes Classification System===
Dukes classification was first proposed by Dr Cuthbert E. Dukes in 1932.<ref>Dukes CE. The classification of cancer of the rectum. ''Journal of Pathological Bacteriology'' 1932;35:323.</ref>


===Dukes' system===
The following table describes the Duke's classification stages.
Dukes' classification, first proposed by Dr Cuthbert E. Dukes in 1932, identifies the stages as:<ref>Dukes CE. The classification of cancer of the rectum. ''Journal of Pathological Bacteriology'' 1932;35:323.</ref>
* A - Tumour confined to the intestinal wall
* B - Tumour invading through the intestinal wall
* C - With lymph node(s) involvement
* D - With distant metastasis


===TNM system===
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
 
| style="background:#f0f0f0;" align="center" |'''Stage'''
 
| style="background:#f0f0f0;" align="center" |'''Description'''
 
|-
 
| A||Tumor confined to the intestinal wall
 
|-
 
| B||Tumor invading through the intestinal wall
 
|-
 
| C||With lymph node(s) involvement
 
|-
 
| D||With distant metastasis
 
|}
===TNM Classification System===
{{main|TNM}}
{{main|TNM}}
The most common current staging system is the [[TNM]] (for tumors/nodes/metastases) system, though many doctors still use the older Dukes system. The [[TNM]] system assigns a number<ref>
The most common staging system is the [[TNM]] classification (tumors/nodes/metastases) system. The [[TNM]] classification system assigns a number<ref>{{cite book  
{{cite book  
|author=Wittekind, Ch; Sobin, L. H.  
|author=Wittekind, Ch; Sobin, L. H.  
|title=TNM classification of malignant tumours  
|title=TNM classification of malignant tumours  
Line 29: Line 57:
|oclc=  
|oclc=  
|doi=
|doi=
}}</ref>:
}}</ref>.
* T - The degree of invasion of the intestinal wall
 
** T0 - no evidence of tumor
The table below displays which TNM values represent which stage.
** Tis- cancer in situ (tumor present, but no invasion)
 
** T1 - invasion through submucosa into lamina propria (basement membrane invaded)
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
** T2 - invasion into the muscularis propria (i.e. proper muscle of the bowel wall)
 
** T3 - invasion through the subserosa
| style="background:#f0f0f0;" align="center" |'''Stage'''
** T4 - invasion of surrounding structures (e.g. bladder) or with tumour cells on the free external surface of the bowel
 
* N - the degree of [[lymphatic]] node involvement
| style="background:#f0f0f0;" align="center" |'''TNM Value'''
** N0 - no [[lymph node]]s involved
 
** N1 - one to three nodes involved
|-
** N2 - four or more nodes involved
 
* M - the degree of [[metastasis]]
| '''0'''||Tis, N0, M0
** M0 - no metastasis
 
** M1 - metastasis present
|-
 
| '''I'''||T1, N0, M0; T2, N0, M0
 
|-
 
| '''IIA'''||T3, N0, M0
 
|-
 
| '''IIB'''||T4, N0, M0
 
|-
 
| '''IIIA'''||T1, N1, M0; T2, N1, M0
 
|-
 
| '''IIIB'''||T3, N1, M0; T4, N1, M0
 
|-
 
| '''IIIC'''||Any T, N2, M0
 
|-
 
| '''IV'''||Any T, Any N, M1
|}   
 
==References==
{{Reflist|2}}


=== AJCC stage groupings ===
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Mature chapter]]


The stage of a cancer 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.
{{WikiDoc Help Menu}}
* Stage 0
{{WikiDoc Sources}}
** Tis, N0, M0
[[Category:Up-To-Date]]
* Stage I
[[Category:Oncology]]
** T1, N0, M0
[[Category:Medicine]]
** T2, N0, M0
[[Category:Gastroenterology]]
* Stage IIA
[[Category:Surgery]]
** T3, N0, M0
* Stage IIB
** T4, N0, M0
* Stage IIIA
** T1, N1, M0
** T2, N1, M0
* Stage IIIB
** T3, N1, M0
** T4, N1, M0
* Stage IIIC
** Any T, N2, M0
* Stage IV
** Any T, Any N, M1

Latest revision as of 20:55, 15 December 2017

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To view the staging of familial adenomatous polyposis (FAP), click here
To view the staging of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.

Overview

Colorectal cancer staging is an estimate of the amount of penetration of the cancer. It is performed for diagnostic and research purposes and to determine the optimal method of treatment. Staging is based on the TNM classification system which depends on the extent of local invasion, the degree of lymph node involvement, and whether there is distant metastasis. The staging systems are called Duke's classification, TNM classification, and AJCC stage grouping.

Colorectal Cancer Staging

Dukes Classification System

Dukes classification was first proposed by Dr Cuthbert E. Dukes in 1932.[1]

The following table describes the Duke's classification stages.

Stage Description
A Tumor confined to the intestinal wall
B Tumor invading through the intestinal wall
C With lymph node(s) involvement
D With distant metastasis

TNM Classification System

Main article: TNM

The most common staging system is the TNM classification (tumors/nodes/metastases) system. The TNM classification system assigns a number[2].

The table below displays which TNM values represent which stage.

Stage TNM Value
0 Tis, N0, M0
I T1, N0, M0; T2, N0, M0
IIA T3, N0, M0
IIB T4, N0, M0
IIIA T1, N1, M0; T2, N1, M0
IIIB T3, N1, M0; T4, N1, M0
IIIC Any T, N2, M0
IV Any T, Any N, M1

References

  1. ↑ Dukes CE. The classification of cancer of the rectum. Journal of Pathological Bacteriology 1932;35:323.
  2. ↑ Wittekind, Ch; Sobin, L. H. (2002). TNM classification of malignant tumours. New York: Wiley-Liss. ISBN 0-471-22288-7.


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