Colon Cancer (Colorectal Cancer)

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Colorectal Cancer Staging

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
• TNM Staging
• Stage Grouping

Modified Duke Staging System

Modified Duke A	The tumor penetrates into the mucosa of the bowel wall but no further.
Modified Duke B	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.
Modified Duke C	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.
Modified Duke D	The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).

TNM Staging System (Tumor, Node, Metastasis)

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.

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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