Colorectal Cancer Staging


  • International meeting

    • 1977, World Health Organization at Turin   

    • 1979, World health Organization at Brussels

        *EORTC (European Organization for Research on Treatment of Cancer)

        *NCI (National Cancer Institute, USA)

        *NSABP (National Surgical Adjuvant Breast and Bowel Project)

        *NCCTG (North Central Cancer Treatment Group)

        *IUAC (International Union Against Cancer)

        *COMECON(Council for Mutual Economic Aid)

        *ECOG (Eastern Cooperative Oncology Group)

        *MRC

        *SAKK

        *SWOG

        *VA

  • Staging System

    • Dukes’ system or pTNM system (UICC)

    • Clinical staging, Endosonographic or Surgicopathologic staging

     

  • Colon and Rectal Cancer

    • TNM system

      • T-primary tumor

        • TX    Primary tumor can not be accessed

        • T0    No evidence of primary tumor

        • Tis    Carcinoma in situ

        • T1    Invades submucosa

        • T2    Invades muscularis propria

        • T3    Invades through muscularis propria into subserosa or into non-peritonealized pericolic or perirectal tissue

        • T4    Perforates the visceral peritoneum or directly invades other organs or structures (includes other segment of colorectum by way of the serosa)

      • N-regional lymph nodes

        • NX    Regional lymph nodes can not be accessed

        • N0    No regional lymph node metastasis

        • N1    Metastasis in 1~3 pericolic or perirectal lymph nodes

        • N2    Metastasis in 4 or more pericolic or perirectal lymph nodes

        • N3    Metastasis in any lymph node along the course of a named vascular trunk

      • M-Distant metastasis

        • MX    presence of distant metastasis can not be accessed

        • M0    No distant metastasis

        • M1    Distant metastasis

          • Pulmonary(PUL), Osseous(OSS), Hepatic(HEP), Brain(BRA), Lymph nodes(LYM), Bone marrow(MAR), Pleura(PLE), Peritoneum(PER), Skin(SKI), Other(OTH)

      • Stage Grouping

        Stage 0 Tis N0 M0
        Stage I T1 N0 M0
        Stage II T2~4 N0 M0
        Stage III Any T N1~3 M0
        Stage IV Any T Any N M1
    • Modified Dukes's system

      • A      penetrated into and limited to submucosa

      • B1    penetrated into muscularis propria

      • B2    through the muscularis propria into the pericolic or mesentic tissue

      • B3    Contiguous organ involvement

      • C      B with regional lymph nodes involvement

      • D      Unresectable tumor, any residual tumor, tumor with distant metastasis

       

  • Anal Cancer

    • Squamous cell carcinoma or Cloacogenic carcinoma

    • TNM system

      • T-primary tumor

        • TX    Primary tumor can not be accessed

        • T0    No evidence of primary tumor

        • Tis    Carcinoma in situ

        • T1    2cm or less in greatest dimension

        • T2    more than 2cm but not more than 5cm in greatest dimension

        • T3    more than 5cm in greatest dimension

        • T4    any size invades adjacent organ(s), e.g. vagina, urethra, bladder (exclude sphincter muscles along)

      • N-regional lymph nodes

        • NX    Regional lymph nodes can not be accessed

        • N0    No regional lymph node metastasis

        • N1    Metastasis in perirectal lymph node(s)

        • N2    Metastasis in unilateral internal iliac and/or inguinal lymph node(s)

        • N3    Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac lymph nodes

      • M-Distant metastasis

        • MX    presence of distant metastasis can not be accessed

        • M0    No distant metastasis

        • M1    Distant metastasis

      • Stage Grouping

        Stage 0 Tis N0 M0
        Stage I T1 N0 M0
        Stage II T2~3 N0 M0
        Stage III A T1~3 N1 M0
        T4 N0 M0
        Stage III B Any T N2~3 M0
        T4 N1 M0
        Stage IV Any T Any N M1