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Stage Information for Rectal Cancer

    Treatment decisions should be made with reference to the TNM classification system,[1] rather than 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 the tumor.[2,3,4] This recommendation takes into consideration that the number of lymph nodes examined is a reflection of both the aggressiveness of lymphovascular mesenteric dissection at the time of surgical resection and the pathologic identification of nodes in the specimen. Retrospective studies, such as Intergroup trial INT-0089 [EST-2288], have demonstrated that the number of lymph nodes examined in colon and rectal surgery may be associated with patient outcome.[5,6,7,8]

    The staging system does not apply to the following histologies:

    • Sarcoma. (See the PDQ summary on Adult Soft Tissue Sarcoma Treatment for more information.)
    • Lymphoma. (See the PDQ summary on Adult Hodgkin Lymphoma Treatment for more information.)
    • Carcinoid tumors. (See the PDQ summary on Gastrointestinal Carcinoid Tumors Treatment for more information.)
    • Melanoma. (See the PDQ summary on Melanoma Treatment for more information.)

    Definitions of TNM

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


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