staging of colorectal carcinoma
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Indications
Clinical significance
Table
| Duke's Stage | Extent of neoplasm | 5 year survival |
|---|---|---|
| A | mucosal & submucosal | 90% |
| B | muscularis involvement | 90% |
| B2 | extending through the muscularis | 67% |
| - | no lymph node involvement | - |
| C1 | lymph node involvement | 65% |
| - | tumor does not penetrate bowel wall | - |
| C2 | lymph node involvement | 50% |
| - | tumor penetrates bowel wall | - |
| D | distant metastasis | <5% |
| Duke's stage | # stage | TNM | 5-year disease-free survival | |
|---|---|---|---|---|
| A | 1 | T1/T2, N0, M0 | 90-95% | |
| B | 2A | T3, N0, M0 | 70-85% | |
| B | 2B | T4, N0, M0 | - | |
| C | 3A | T1/T2, N1, M0 | 25-70% | |
| C | 3B | T3/T4, N1, M0 | - | |
| C | 3C | T any, N2, M0 | - | |
| D | 4 | T any, N any, M1 | 0-10% |
TNM staging[1]
- T: primary tumor
- Tx: primary tumor cannot be assessed
- T0: no evidence of primary tumor
- Tis: carcinoma in situ: intraepithelilial or invasion of the lamina propria
- T1: tumor invades submucosa
- T2: tumor invades muscularis propria
- T3: tumor invades through muscularis propria into the subserosa or into non-peritoneal pericolic or perirectal tissues
- T4: tumor directly invades other organs or structures &/or perforates visceral peritoneum
- N: regional lymph nodes
- Nx: regional lymph nodes cannot be assessed
- N0: no regional lymph node metastasis
- N1: metastasis in 1-3 regional lymph nodes
- N2: metastasis in 4 or more regional lymph nodes
- M: distant metastasis
- MX: distant metastasis cannot be assessed
- M0: no distant metastasis
- M1: distant metastasis
Survival increases with number of lymph nodes biopsied, whether or not lymph nodes are positive for metastatic disease, thus at least 12 lymph nodes should be biopsied during staging[1]
No role for sentinal lymph node biopsy; does not improve staging.[3]
| Duke's stage | # stage | TNM | 5-year disease-free survival | |
|---|---|---|---|---|
| A | 1 | T1/T2, N0, M0 | 90-95% | |
| B | 2A | T3, N0, M0 | 70-85% | |
| B | 2B | T4, N0, M0 | - | |
| C | 3A | T1/T2, N1, M0 | 25-70% | |
| C | 3B | T3/T4, N1, M0 | - | |
| C | 3C | T any, N2, M0 | - | |
| D | 4 | T any, N any, M1 | 0-10% |
TNM staging[1]
- T: primary tumor
- Tx: primary tumor cannot be assessed
- T0: no evidence of primary tumor
- Tis: carcinoma in situ: intraepithelilial or invasion of the lamina propria
- T1: tumor invades submucosa
- T2: tumor invades muscularis propria
- T3: tumor invades through muscularis propria into the subserosa or into non-peritoneal pericolic or perirectal tissues
- T4: tumor directly invades other organs or structures &/or perforates visceral peritoneum
- N: regional lymph nodes
- Nx: regional lymph nodes cannot be assessed
- N0: no regional lymph node metastasis
- N1: metastasis in 1-3 regional lymph nodes
- N2: metastasis in 4 or more regional lymph nodes
- M: distant metastasis
- MX: distant metastasis cannot be assessed
- M0: no distant metastasis
- M1: distant metastasis
Survival increases with number of lymph nodes biopsied, whether or not lymph nodes are positive for metastatic disease, thus at least 12 lymph nodes should be biopsied during staging[1]
No role for sentinal lymph node biopsy; does not improve staging.[3]
Procedure
- colonoscopy
- contrast-enhanced CT of thorax
- contrast-enhanced CT of abdomend & pelvis
- preoperative PET scan does not improve staging[1]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17, 18 American College of Physicians, Philadelphia 1998, 2009, 2015, 2018
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 575
- ↑ 3.0 3.1 3.2 Lim SJ, Feig BW, Wang H, Hunt KK, Rodriguez-Bigas MA, Skibber JM, Ellis V, Cleary K, Chang GJ. Sentinel lymph node evaluation does not improve staging accuracy in colon cancer. Ann Surg Oncol. 2008 Jan;15(1):46-51. Epub 2007 Nov 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17985187