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Stage Information for Colon Cancer

    Treatment decisions should be made with reference to the TNM classification [1] rather than to the older Dukes or the Modified Astler-Coller classification schema.

    The American Joint Committee on Cancer (AJCC) and a National Cancer Institute–sponsored panel recommended that at least 12 lymph nodes be examined in patients with colon and rectal cancer to confirm the absence of nodal involvement by tumor.[2,3,4] This recommendation takes into consideration that the number of lymph nodes examined is a reflection of the aggressiveness of lymphovascular mesenteric dissection at the time of surgical resection and the pathologic identification of nodes in the specimen. Retrospective studies demonstrated that the number of lymph nodes examined in colon and rectal surgery may be associated with patient outcome.[5,6,7,8]

    AJCC Stage Groupings and TNM Definitions

    The AJCC has designated staging by TNM classification to define colon cancer.[1] The same classification is used for both clinical and pathologic staging.[1]

    Table 1. Definitions of TNM Stage 0

    StageTNMa,bDukescMACdDescriptionIllustration
    T = primary tumor; N = regional lymph nodes; M = distant metastasis.
    Reprinted with permission from AJCC: Colon and rectum. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 143-164.
    The explanations for superscripts a–g are at the end ofTable 5.
    0
    Tis, N0, M0
    Tis = Carcinomain situ: intraepithelial or invasion of lamina propria.e

    cdr0000688354.jpg
    N0 = No regional lymph node metastasis.
    M0 = No distant metastasis.

    Table 2. Definitions of TNM Stage I

    StageTNMa,bDukescMACdDescriptionIllustration
    T = primary tumor; N = regional lymph nodes; M = distant metastasis.
    Reprinted with permission from AJCC: Colon and rectum. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 143-164.
    The explanations for superscripts a–g are at the end ofTable 5.
    I
    T1, N0, M0
    A
    A
    T1 = Tumor invades submucosa.

    cdr0000688427.jpg
    T2 = Tumor invades muscularis propria.
    N0 = No regional lymph node metastasis.
    T2, N0, M0AB1M0 = No distant metastasis.
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