Staging
of colon Cancer
Staging is a
method of evaluating the progress of the cancer in a patient. That is,
it looks at the tumor and the extent to which it has spread to other
parts of the body. Once doctors know how far along the cancer is, they
can decide on the best course of treatment.
The staging of colon cancer is relatively straightforward. Originally
there was the Duke's classification system, which placed patients into
one of three categories (Stages A, B,C). This system was subsequently
modified by Astler-Coller to include a fourth stage (Stage D);
Gunderson & Sosin subsequently modified it again in 1978. More
recently, the American Joint Committee on Cancer (AJCC) has introduced
the TNM staging system, which places patients into one of four stages
(Stage I-IV). Listed below are the Duke and TNM staging systems (they
are the most often used).
Modified Duke Staging System
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Modified Duke A
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The tumor penetrates into the mucosa of the bowel wall but no further.
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Modified Duke B
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B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall.
B2: tumor penetrates into and through the muscularis propria of the bowel wall.
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Modified Duke C
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C1:
tumor penetrates into, but not through the muscularis propria of the
bowel wall; there is pathologic evidence of colon cancer in the lymph
nodes.
C2: tumor penetrates into and through the muscularis propria of the bowel wall;
there is pathologic evidence of colon cancer in the lymph nodes.
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Modified Duke D
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The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).
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TNM Staging System (Tumor, Node, Metastisis)
- Tumor
-
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into
the pericolic or perirectal tissues.
T4: Tumor directly invades other organs or structures, and/or perforates.
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Node
-
N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.
-
Metastasis
-
M0: No distant metastasis.
M1: Distant metastasis present.
Stage Groupings
Stage I: T1 N0 M0; T2 N0 M0
Cancer has begun to spread, but is still in the inner lining.
Stage II: T3 N0 M0; T4 N0 M0
Cancer has spread to other organs near the colon or rectum. It has not reached lymph nodes.
Stage III: any T, N1-2, M0
Cancer has spread to lymph nodes, but has not been carried to distant parts of the body
Stage IV: any T, any N, M1
Cancer has been carried through the lymph system to distant parts
of the body. This is known as metastasis. The most likely organs to
experience metastasis from colorectal cancer are the lungs and liver.
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