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e-CASES: TNM colon-rectum - 7th Edition

Dr Antoine Micheau , CHU ARNAUD DE VILLENEUVE , Montpellier , Herault , FRANCE

Primary Tumor (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 pericolorectal tissues
  • 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)

  • NX Regional lymph nodes cannot be assessed
  • N0 No regional lymph node metastasis
  • N1 Metastasis in 1–3 regional 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

Distant Metastasis (M)

  • 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   T   N M Dukes MAC
0 Tis N0   M0  
I T1 N0   M0 A A  
  T2 N0   M0 A B1
IIA T3 N0   M0 B B2
IIB T4a N0   M0 B B2
IIC T4b N0   M0 B B3
IIIA T1–T2 N1/N1c M0 C C1
  T1 N2a M0 C C1
IIIB T3–T4a N1/N1c M0 C C2
  T2–T3 N2a M0 C C1/C2
  T1–T2 N2b M0 C C1
IIIC T4a N2a M0 C C2
  T3–T4a N2b M0 C C2
  T4b N1–N2 M0 C C3
IVA Any T Any N M1a

IVB Any T Any N M1b

 

Appendix ileocolic
Caecum ileocolic, right colic
Ascending colon ileocolic, right colic, middle colic
Hepatic flexure middle colic, right colic
Transverse colon right colic, middle colic, left colic, inferior mesenteric
Splenic flexure middle colic, left colic, inferior mesenteric
Descending colon left colic, inferior mesenteric
Sigmoid colon sigmoid, left colic, superior rectal (haemorrhoidal), inferior mesenteric and rectosigmoid
Rectum superior, middle, and inferior rectal (haemorrhoidal), inferior mesenteric, internal iliac, mesorectal (paraproctal), lateral sacral, presacral, sacral promontory (Gerota)