This site is targeted at medical and radiology professionals, contains user contributed content, and material that may be confusing to a lay audience. Use of this site implies acceptance of our Terms of Use.

Rectal cancer staging

Staging strongly influences the success of, and rate of local recurrence following rectal cancer resection.

TNM staging

See : TNM staging system for a general description.

Primary tumour staging (T)
  • Tx - primary tumour cannot be assessed
  • T0 - no evidence of primary tumour
  • Tis - carcinoma in situ: intraepithelial or invasion of lamina propria
  • T1 - tumour invades submucosa
  • T2 - tumour invades muscularis propria
  • T3 - tumour invades through the muscularis propria into the subserosa or into non-peritonealised peri-rectal tissues
    • T3a - tumour extends < 1mm beyond muscularis propria 4
    • T3b - tumour extends 1-5 mm beyond muscularis propria 4
    • T3c - tumour extends 5-15 mm beyond muscularis propria 4
    • T3d - tumour extends 15 mm beyond muscularis propria 4
  • T4 - tumour invades directly into other organs or structures and/or perforates visceral peritoneum
    • T4a - tumour penetrates to the surface of the visceral peritoneum
    • T4b - tumour directly invades or is adherent to other organs or structures
Regional lymph nodes (N)

The size cut off for mesorectal nodes is usually taken at 5mm 6

  • Nx - regional nodes not assessed
  • N0 - no regional lymph nodes
  • N1 - metastasis in 1-3 regional (peri-rectal) lymph nodes
    •  
    • N1a  - metastasis in one regional lymph node
    • N1b  - metastasis in 2–3 regional lymph nodes
    • N1c - tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal  tissues without regional nodal metastasis
  • N2 - metastasis in 4 or more regional lymph nodes
    •  
    • N2a - metastasis in 4–6 regional lymph nodes
    • N2b - metastasis in 7 or more regional lymph nodes
  • Mx : cannot be assessed
  • M0 : no distant metastasis
  • M1 : distant metastasis
    • M1a  - metastasis confined to one organ or site (for example, liver, lung, ovary, nonregional node)
    • M1b - metastases in more than one organ/site or the peritoneum

Stage groupings

  • stage 0 - Tis N0 M0
  • stage I - T1-2, N0 M0
  • stage II
    • IIa - T3, N0, M0
    • IIb - T4a, N0, M0
    • IIc - T4b, No, Mo
  • stage III
    • IIIa - T1-2, N1, M0
    • IIIb - T3-4, N1, M0
    • IIIc - T3-4b, N2, M0
  • stage IV - any T, any N M1

See also

Updating… Please wait.
Loadinganimation

 Details successfully updated.

Error Unable to process the form. Check for errors and try again.

 Thank you for updating your details.