Colorectal cancer staging

By
  • Dr Antoine Micheau

Publication date: September 26, 2012 | Updated on December 19, 2012

Report

Diagnosis

Colorectal cancer staging

History

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)