Difference between revisions of "Colorectal cancer staging"
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(T3 looks like it is thru... removing) |
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| T4a | | T4a | ||
| invasion of the visceral peritoneum | | invasion of the visceral peritoneum | ||
| | | tumour within 1 mm is ''not'' T4a; however, it should prompt cutting [[deepers]] and taking more sections | ||
|- | |- | ||
| T4b | | T4b | ||
| Line 42: | Line 42: | ||
! Stage | ! Stage | ||
! Criteria | ! Criteria | ||
! Notes | |||
|- | |- | ||
|N0 | |N0 | ||
| no positive nodes | | no positive nodes | ||
| | |||
|- | |- | ||
| N1a | | N1a | ||
| 1 positive node | | 1 positive node | ||
| | |||
|- | |- | ||
| N1b | | N1b | ||
| 2-3 positive nodes | | 2-3 positive nodes | ||
| | |||
|- | |- | ||
| N1c | | N1c | ||
| [[tumour deposit|tumour deposit(s)]] present with all lymph nodes negative | | [[tumour deposit|tumour deposit(s)]] present with all lymph nodes negative | ||
| lesion must be in the drainage bed of the tumour; lesions ''not'' in the drainage bed are M1b | |||
|- | |- | ||
| N2a | | N2a | ||
| 4-6 positive nodes | | 4-6 positive nodes | ||
| | |||
|- | |- | ||
| N2b | | N2b | ||
| 7+ positive nodes | | 7+ positive nodes | ||
| | |||
|} | |} | ||
Notes: | Notes: | ||
*Memory device for N2 = 4+ positive LNs: the number ''four'' in chinese sounds like ''death''.<ref>URL: [http://en.wikipedia.org/wiki/Numbers_in_Chinese_culture#Four http://en.wikipedia.org/wiki/Numbers_in_Chinese_culture#Four]. Accessed on: 28 June 2011.</ref> | *Memory device for N2 = 4+ positive LNs: the number ''four'' in chinese sounds like ''death''.<ref>URL: [http://en.wikipedia.org/wiki/Numbers_in_Chinese_culture#Four http://en.wikipedia.org/wiki/Numbers_in_Chinese_culture#Four]. Accessed on: 28 June 2011.</ref> | ||
*Tumour deposits are counted separately. | |||
**Tumour deposits are ''not'' considered lymph nodes. | |||
===Metastasis stage=== | ===Metastasis stage=== | ||
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|- | |- | ||
| M1a | | M1a | ||
| | | one organ only | ||
| [[lung metastasis|lung]], [[liver metastasis|liver]], ovary or nonregional [[lymph node]] | | [[lung metastasis|lung]], [[liver metastasis|liver]], ovary or nonregional [[lymph node]] | ||
|- | |- | ||
| M1b | | M1b | ||
| more than one organ or peritoneal involvement | | more than one organ or peritoneal involvement | ||
| [[tumour deposit]]s are in the drainage bed of the tumour | | [[tumour deposit]]s are in the drainage bed of the tumour - they are not classified as metastases | ||
|} | |} | ||
| Line 98: | Line 107: | ||
*Stage IIIC - Tx N2. | *Stage IIIC - Tx N2. | ||
*Stage IV - Tx Nx M1. | *Stage IV - Tx Nx M1. | ||
Note: | |||
*[[Tumour perforation in colorectal cancer]] is poor prognosticator;<ref name=pmid17049848>{{Cite journal | last1 = Anwar | first1 = MA. | last2 = D'Souza | first2 = F. | last3 = Coulter | first3 = R. | last4 = Memon | first4 = B. | last5 = Khan | first5 = IM. | last6 = Memon | first6 = MA. | title = Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. | journal = Surg Oncol | volume = 15 | issue = 2 | pages = 91-6 | month = Aug | year = 2006 | doi = 10.1016/j.suronc.2006.09.001 | PMID = 17049848 }}</ref> however, it does ''not'' affect the (overall) stage. It been suggested that perforated colorectal carcinoma be considered stage IV.<ref name=pmid19443386>{{Cite journal | last1 = Ogawa | first1 = M. | last2 = Watanabe | first2 = M. | last3 = Eto | first3 = K. | last4 = Omachi | first4 = T. | last5 = Kosuge | first5 = M. | last6 = Hanyu | first6 = K. | last7 = Noaki | first7 = L. | last8 = Fujita | first8 = T. | last9 = Yanaga | first9 = K. | title = Clinicopathological features of perforated colorectal cancer. | journal = Anticancer Res | volume = 29 | issue = 5 | pages = 1681-4 | month = May | year = 2009 | doi = | PMID = 19443386 }}</ref> | |||
==See also== | ==See also== | ||
Latest revision as of 16:28, 18 March 2018
This article deals with colorectal cancer staging.
General
TNM staging is very widely used. There is also the Dukes' system, which in many respects is quite similar.[1]
TNM staging system
Tumour stage
| Stage | Criteria | Notes |
|---|---|---|
| Tis | in situ (intramucosal) ‡ | high-grade dysplasia, "intramucosal colorectal carcinoma", and "colorectal adenocarcinoma in situ" are used interchangeably by many in the colon and rectum; high-grade dysplasia is the preferred term - see "intramucosal colorectal carcinoma" |
| T1 | into submucosa (through mucularis mucosae), not into muscularis propria | different than elsewhere in GI tract; in the small bowel tumour cells in the lamina propria is defined as T1; rationale for the T1 definition in CRC is that no lymphatics are present in the mucosa, ergo no risk of distant spread |
| T2 | into muscularis propria | |
| T3 | into fat beyond musclaris propria | |
| T4a | invasion of the visceral peritoneum | tumour within 1 mm is not T4a; however, it should prompt cutting deepers and taking more sections |
| T4b | grows into something else |
Nodal stage
Nodal stage as per AJCC 7th edition:[2]
| Stage | Criteria | Notes |
|---|---|---|
| N0 | no positive nodes | |
| N1a | 1 positive node | |
| N1b | 2-3 positive nodes | |
| N1c | tumour deposit(s) present with all lymph nodes negative | lesion must be in the drainage bed of the tumour; lesions not in the drainage bed are M1b |
| N2a | 4-6 positive nodes | |
| N2b | 7+ positive nodes |
Notes:
- Memory device for N2 = 4+ positive LNs: the number four in chinese sounds like death.[3]
- Tumour deposits are counted separately.
- Tumour deposits are not considered lymph nodes.
Metastasis stage
Metastasis stage as per AJCC 7th edition:[2]
| Stage | Criteria | Notes |
|---|---|---|
| M1a | one organ only | lung, liver, ovary or nonregional lymph node |
| M1b | more than one organ or peritoneal involvement | tumour deposits are in the drainage bed of the tumour - they are not classified as metastases |
Overall stage
Simple version
Tumour/node grade for stage:[4]
- Stage I - T1 or T2 N0 M0.
- Stage II - T3 or T4 N0 M0.
- Stage III - Tx N1 or N2 M0.
- Stage IV - Tx Nx M1.
Complex version
Detailed tumour/node grade for stage:[5]
- Stage I - T1 or T2.
- Stage IIA - T3.
- Stage IIB - T4.
- Stage IIIA - T1 N1 or T2 N1.
- Stage IIIB - T3 N1 or T4 N1.
- Stage IIIC - Tx N2.
- Stage IV - Tx Nx M1.
Note:
- Tumour perforation in colorectal cancer is poor prognosticator;[6] however, it does not affect the (overall) stage. It been suggested that perforated colorectal carcinoma be considered stage IV.[7]
See also
References
- ↑ URL: http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/treatment/dukes-stages-of-bowel-cancer. Accessed on: 12 January 2016.
- ↑ 2.0 2.1 American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 198. ISBN 978-0387884424.
- ↑ URL: http://en.wikipedia.org/wiki/Numbers_in_Chinese_culture#Four. Accessed on: 28 June 2011.
- ↑ Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. GS27. ISBN 978-0968592861.
- ↑ http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_colon_and_rectum_cancer_staged.asp
- ↑ Anwar, MA.; D'Souza, F.; Coulter, R.; Memon, B.; Khan, IM.; Memon, MA. (Aug 2006). "Outcome of acutely perforated colorectal cancers: experience of a single district general hospital.". Surg Oncol 15 (2): 91-6. doi:10.1016/j.suronc.2006.09.001. PMID 17049848.
- ↑ Ogawa, M.; Watanabe, M.; Eto, K.; Omachi, T.; Kosuge, M.; Hanyu, K.; Noaki, L.; Fujita, T. et al. (May 2009). "Clinicopathological features of perforated colorectal cancer.". Anticancer Res 29 (5): 1681-4. PMID 19443386.