Colorectal Cancer Staging

• International meeting

  • 1977, World Health Organization at Turin   

  • 1979, World health Organization at Brussels

        *EORTC (European Organization for Research on Treatment of Cancer)

        *NCI (National Cancer Institute, USA)

        *NSABP (National Surgical Adjuvant Breast and Bowel Project)

        *NCCTG (North Central Cancer Treatment Group)

        *IUAC (International Union Against Cancer)

        *COMECON(Council for Mutual Economic Aid)

        *ECOG (Eastern Cooperative Oncology Group)

        *MRC

        *SAKK

        *SWOG

        *VA

• Staging System

  • Dukes’ system or pTNM system (UICC)

  • Clinical staging, Endosonographic or Surgicopathologic staging

  　

• Colon and Rectal Cancer

  • TNM system

    • T-primary tumor

      • TX    Primary tumor can not be accessed

      • T0    No evidence of primary tumor

      • Tis    Carcinoma in situ

      • T1    Invades submucosa

      • T2    Invades muscularis propria

      • T3    Invades through muscularis propria into subserosa or into non-peritonealized pericolic or perirectal tissue

      • T4    Perforates the visceral peritoneum or directly invades other organs or structures (includes other segment of colorectum by way of the serosa)

    • N-regional lymph nodes

      • NX    Regional lymph nodes can not be accessed

      • N0    No regional lymph node metastasis

      • N1    Metastasis in 1~3 pericolic or perirectal lymph nodes

      • N2    Metastasis in 4 or more pericolic or perirectal lymph nodes

      • N3    Metastasis in any lymph node along the course of a named vascular trunk

    • M-Distant metastasis

      • MX    presence of distant metastasis can not be accessed

      • M0    No distant metastasis

      • M1    Distant metastasis

        • Pulmonary(PUL), Osseous(OSS), Hepatic(HEP), Brain(BRA), Lymph nodes(LYM), Bone marrow(MAR), Pleura(PLE), Peritoneum(PER), Skin(SKI), Other(OTH)

    • Stage Grouping

      Stage 0	Tis	N0	M0
      Stage I	T1	N0	M0
      Stage II	T2~4	N0	M0
      Stage III	Any T	N1~3	M0
      Stage IV	Any T	Any N	M1

  • Modified Dukes's system

    • A      penetrated into and limited to submucosa

    • B1    penetrated into muscularis propria

    • B2    through the muscularis propria into the pericolic or mesentic tissue

    • B3    Contiguous organ involvement

    • C      B with regional lymph nodes involvement

    • D      Unresectable tumor, any residual tumor, tumor with distant metastasis

    　

• Anal Cancer

  • Squamous cell carcinoma or Cloacogenic carcinoma

  • TNM system

    • T-primary tumor

      • TX    Primary tumor can not be accessed

      • T0    No evidence of primary tumor

      • Tis    Carcinoma in situ

      • T1    2cm or less in greatest dimension

      • T2    more than 2cm but not more than 5cm in greatest dimension

      • T3    more than 5cm in greatest dimension

      • T4    any size invades adjacent organ(s), e.g. vagina, urethra, bladder (exclude sphincter muscles along)

    • N-regional lymph nodes

      • NX    Regional lymph nodes can not be accessed

      • N0    No regional lymph node metastasis

      • N1    Metastasis in perirectal lymph node(s)

      • N2    Metastasis in unilateral internal iliac and/or inguinal lymph node(s)

      • N3    Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac lymph nodes

    • M-Distant metastasis

      • MX    presence of distant metastasis can not be accessed

      • M0    No distant metastasis

      • M1    Distant metastasis

    • Stage Grouping

      Stage 0	Tis	N0	M0
      Stage I	T1	N0	M0
      Stage II	T2~3	N0	M0
      Stage III A	T1~3	N1	M0
      	T4	N0	M0
      Stage III B	Any T	N2~3	M0
      	T4	N1	M0
      Stage IV	Any T	Any N	M1