Colorectal cancer staging: Difference between revisions
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{{ | {{Colorectal cancer}} | ||
To view the staging of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis staging|'''here''']]<br> | |||
To view the staging of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer staging|'''here''']]<br><br> | |||
{{CMG}} {{AE}} Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D. | |||
==Overview== | |||
Colorectal cancer staging is an estimate of the amount of penetration of the cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers largely depend on the extent of local invasion, the degree of lymph node involvement, and whether there is distant [[metastasis]]. The staging systems are called Duke's classification, TMN classification, and AJCC stage grouping. | |||
==Staging== | ==Colorectal Cancer Staging== | ||
Colorectal cancer staging is an estimate of the amount of penetration of the cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers largely depend on the extent of local invasion, the degree of lymph node involvement, and whether there is distant [[metastasis]]. | |||
Definitive staging can only be done after [[Colectomy|surgery]] has been performed and | Definitive staging can only be done after [[Colectomy|surgery]] has been performed and pathology reports have been reviewed. An exception to this principle would be after a colonoscopic polypectomy of a malignant pedunculated polyp with minimal invasion. Preoperative staging of rectal cancers may be done with [[endoscopic ultrasound]]. Adjuncts to staging of metastasis include [[Medical ultrasonography|abdominal ultrasound]], [[Computed tomography|CT]], [[Positron emission tomography|PET scanning]], and other imaging studies. | ||
===Dukes | ===Dukes Classification System=== | ||
Dukes | Dukes classification, first proposed by Dr Cuthbert E. Dukes in 1932, identifies the stages as:<ref>Dukes CE. The classification of cancer of the rectum. ''Journal of Pathological Bacteriology'' 1932;35:323.</ref> | ||
* A - Tumour confined to the intestinal wall | *A - Tumour confined to the intestinal wall | ||
* B - Tumour invading through the intestinal wall | *B - Tumour invading through the intestinal wall | ||
* C - With lymph node(s) involvement | *C - With lymph node(s) involvement | ||
* D - With distant metastasis | *D - With distant metastasis | ||
===TNM | ===TNM Classification System=== | ||
{{main|TNM}} | {{main|TNM}} | ||
The most common current staging system is the [[TNM]] ( | The most common current staging system is the [[TNM]] classification (tumors/nodes/metastases) system, though many doctors still use the older Dukes system. The [[TNM]] classification system assigns a number<ref> | ||
{{cite book | {{cite book | ||
|author=Wittekind, Ch; Sobin, L. H. | |author=Wittekind, Ch; Sobin, L. H. | ||
| Line 47: | Line 50: | ||
** M1 - metastasis present | ** M1 - metastasis present | ||
=== AJCC | ===AJCC Stage Groupings=== | ||
The stage of a cancer is usually quoted as a number I, II, III, IV derived from the TNM value grouped by prognosis; a higher number indicates a more advanced cancer and likely a worse outcome. | The stage of a cancer is usually quoted as a number I, II, III, IV derived from the TNM value grouped by prognosis; a higher number indicates a more advanced cancer and likely a worse outcome. | ||
* Stage 0 | * Stage 0 | ||
| Line 69: | Line 71: | ||
* Stage IV | * Stage IV | ||
** Any T, Any N, M1 | ** Any T, Any N, M1 | ||
==Grades of Colorectal Cancer== | |||
The grade describes how closely the cancer looks like normal tissue when seen under a microscope. This is sometimes used to distinguish whether a patient should get adjuvant treatment with chemotherapy after surgery. | |||
Grade 1 - Well differentiated | |||
Grade 2 - Moderately differentiated | |||
Grade 3 - Poorly differentiated | |||
Grade 4 - Undifferentiated | |||
==References== | ==References== | ||
Revision as of 17:35, 14 July 2015
Template:Colorectal cancer
To view the staging of familial adenomatous polyposis (FAP), click here
To view the staging of hereditary nonpolyposis colorectal cancer (HNPCC), click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D.
Overview
Colorectal cancer staging is an estimate of the amount of penetration of the cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers largely depend on the extent of local invasion, the degree of lymph node involvement, and whether there is distant metastasis. The staging systems are called Duke's classification, TMN classification, and AJCC stage grouping.
Colorectal Cancer Staging
Colorectal cancer staging is an estimate of the amount of penetration of the cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers largely depend on the extent of local invasion, the degree of lymph node involvement, and whether there is distant metastasis.
Definitive staging can only be done after surgery has been performed and pathology reports have been reviewed. An exception to this principle would be after a colonoscopic polypectomy of a malignant pedunculated polyp with minimal invasion. Preoperative staging of rectal cancers may be done with endoscopic ultrasound. Adjuncts to staging of metastasis include abdominal ultrasound, CT, PET scanning, and other imaging studies.
Dukes Classification System
Dukes classification, first proposed by Dr Cuthbert E. Dukes in 1932, identifies the stages as:[1]
- A - Tumour confined to the intestinal wall
- B - Tumour invading through the intestinal wall
- C - With lymph node(s) involvement
- D - With distant metastasis
TNM Classification System
The most common current staging system is the TNM classification (tumors/nodes/metastases) system, though many doctors still use the older Dukes system. The TNM classification system assigns a number[2]:
- T - The degree of invasion of the intestinal wall
- T0 - no evidence of tumor
- Tis- cancer in situ (tumor present, but no invasion)
- T1 - invasion through submucosa into lamina propria (basement membrane invaded)
- T2 - invasion into the muscularis propria (i.e. proper muscle of the bowel wall)
- T3 - invasion through the subserosa
- T4 - invasion of surrounding structures (e.g. bladder) or with tumour cells on the free external surface of the bowel
- N - the degree of lymphatic node involvement
- N0 - no lymph nodes involved
- N1 - one to three nodes involved
- N2 - four or more nodes involved
- M - the degree of metastasis
- M0 - no metastasis
- M1 - metastasis present
AJCC Stage Groupings
The stage of a cancer is usually quoted as a number I, II, III, IV derived from the TNM value grouped by prognosis; a higher number indicates a more advanced cancer and likely a worse outcome.
- Stage 0
- Tis, N0, M0
- Stage I
- T1, N0, M0
- T2, N0, M0
- Stage IIA
- T3, N0, M0
- Stage IIB
- T4, N0, M0
- Stage IIIA
- T1, N1, M0
- T2, N1, M0
- Stage IIIB
- T3, N1, M0
- T4, N1, M0
- Stage IIIC
- Any T, N2, M0
- Stage IV
- Any T, Any N, M1
Grades of Colorectal Cancer
The grade describes how closely the cancer looks like normal tissue when seen under a microscope. This is sometimes used to distinguish whether a patient should get adjuvant treatment with chemotherapy after surgery. Grade 1 - Well differentiated Grade 2 - Moderately differentiated Grade 3 - Poorly differentiated Grade 4 - Undifferentiated
References
- ↑ Dukes CE. The classification of cancer of the rectum. Journal of Pathological Bacteriology 1932;35:323.
- ↑ Wittekind, Ch; Sobin, L. H. (2002). TNM classification of malignant tumours. New York: Wiley-Liss. ISBN 0-471-22288-7.