Colorectal carcinoma staging can be performed using two systems. The traditional Dukes staging system has largely been replaced by the TNM system but is nonetheless often used clinically.
Staging
Dukes (Astler-Coller modification)
stage A: confined to mucosa
stage B: through muscularis propria
stage C: local lymph node involvement
stage D: distant metastases
TNM staging (8th edition)
Primary tumor staging (T)
Tx: primary tumor cannot be assessed
T0: no evidence of primary tumor
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-peritonealised pericolic/perirectal tissues
T4a: penetration of the visceral peritoneal layer
T4b: penetration or adhesion to adjacent organs
Nodal status (N)
Nx: nodes cannot be assessed
N0: no evidence of nodal involvement
N1a: involvement of one regional node
N1b: involvement of 2-3 regional nodes
N1c: deposits involving serosa or non-peritonealised pericolic/perirectal tissues without regional nodal metastasis
N2a: involvement of 4-6 nodes
N2b: involvement of ≥7 nodes
Metastases (M)
Mx: presence of metastases cannot be assessed
M0: no evidence of metastases
M1a: distant metastases confined to one organ (e.g. liver, lung, ovary, non-regional node), without peritoneal metastases
M1b: distant metastases to more than one organ, but without peritoneal metastases
M1c: metastases to the peritoneum, with or without metastases in other organs
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