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Colorectal cancer staging

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 Duke's has largely been replaced by the TNM system, but is nonetheless often used clinically.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