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Colorectal cancer staging

There are two main staging schemes used in colorectal carcinoma. The traditional Duke's has largely been replaced by the TNM system, but is nonetheless often used clinically.

Duke's (Astler-Coller modification)
  • stage A: confined to mucosa
  • stage B: though muscularis propria
  • stage C: local lymph node involvement
  • stage D: distant metastases
TNM staging
Primary tumour staging (T)
  • Tx: primary tumour cannot be assessed
  • T0: no evidence of primary tumour
  • Tis: carcinoma in situ
  • T1: into (but not through) submucosa
  • T2: into (but not through) muscularis propria
  • T3
    • through muscularis propria into subserosa, or
    • into non-peritonealized pericolic/perirectal tissues
  • T4: direct extension into adjacent organs
Nodal status (N)
  • Nx: nodes cannot be assessed
  • N0: no evidence of nodal involvement
  • N1: involvement of 1 to 3 regional nodes
  • N2: involvement of 4 or more nodes
Metastases (M)
  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

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