Difference between revisions of "Colorectal cancer staging"

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Colorectal cancer staging (view source)

Revision as of 16:28, 18 March 2018

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T3 looks like it is thru... removing
(T3 looks like it is thru... removing)
 
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==General==
==General==
TNM staging is very widely used.
TNM staging is very widely used. There is also the ''Dukes' system'', which in many respects is quite similar.<ref>URL: [http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/treatment/dukes-stages-of-bowel-cancer http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/treatment/dukes-stages-of-bowel-cancer]. Accessed on: 12 January 2016.</ref>


==TNM staging system==
==TNM staging system==
*"[[Colorectal adenocarcinoma in situ]]" and "high-grade dysplasia" is used interchangeably by many in the colon and rectum.
===Tumour stage===
**Splitting hairs - ''adenocarcinoma in situ'' is ''invasion into the lamina propria'', high-grade dysplasia does not have lamina propria invasion. Ergo, the difference amounts to seeing a [[desmoplastic stroma]] (adenocarcinoma) or not seeing one (dysplasia).


===Tumour stage===
{| class="wikitable sortable"
*Tis - in situ (intramucosal).
! Stage
*T1 - into submucosa (through mucularis mucosae).
! Criteria
**This is '''different than elsewhere''', e.g. in the ''small bowel'' tumour cells in the ''lamina propria'' is defined as T1.  The rationale for the ''T1'' definition in CRC is that no lymphatics are present in the mucosa, ergo no risk of distant spread.
! Notes
*T2 - into muscularis propria.
|-
*T3 - into fat beyond musclaris propria.
| Tis  
*T4 - into something else.
| in situ ([[Intramucosal colorectal carcinoma|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
|
|}


===Nodes stage===
===Nodal stage===
*N0 - no positive nodes.
Nodal stage as per AJCC 7th edition:<ref name=Ref_AJCC7HB198>{{Ref AJCC7HB|198}}</ref>
*N1 - 1-3 positive nodes.
{| class="wikitable sortable"
*N2 - 4+ positive nodes.
! Stage
**N2a - 4-6 positive nodes.
! Criteria
**N2b - 7+ positive nodes.
! Notes
|-
|N0  
| no positive nodes
|
|-
| N1a
| 1 positive node
|
|-
| N1b
| 2-3 positive nodes
|
|-
| N1c
| [[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  
| 4-6 positive nodes
|
|-
| N2b  
| 7+ positive nodes
|
|}


Notes:
Notes:
*Memory device for N2 = 4+ +ve 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 as per AJCC 7th edition:<ref name=Ref_AJCC7HB198>{{Ref AJCC7HB|198}}</ref>
{| class="wikitable sortable"
! Stage
! Criteria
! Notes
|-
| M1a
| one organ only
| [[lung metastasis|lung]], [[liver metastasis|liver]], ovary or nonregional [[lymph node]]
|-
| M1b
| more than one organ or peritoneal involvement
| [[tumour deposit]]s are in the drainage bed of the tumour - they are not classified as metastases
|}


==Overall stage==
===Overall stage===
===Simple version===
====Simple version====
Tumour/node grade for stage:<ref>{{Ref TN2006| GS27}}</ref>
Tumour/node grade for stage:<ref>{{Ref TN2006| GS27}}</ref>
*Stage I - '''T1 or T2''' N0 M0.
*Stage I - '''T1 or T2''' N0 M0.
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*Stage IV - Tx Nx '''M1'''.
*Stage IV - Tx Nx '''M1'''.


===Complex version===
====Complex version====
Detailed tumour/node grade for stage:<ref>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_colon_and_rectum_cancer_staged.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_colon_and_rectum_cancer_staged.asp]</ref>
Detailed tumour/node grade for stage:<ref>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_colon_and_rectum_cancer_staged.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_colon_and_rectum_cancer_staged.asp]</ref>
*Stage I - T1 or T2.
*Stage I - T1 or T2.
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*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==
Michael
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