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Stage Information for Rectal Cancer

    Table 2. Regional Lymph Nodes (N)a,b

    a 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.
    b A satellite peritumoral nodule in the pericolorectal adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule may represent discontinuous spread, venous invasion with extravascular spread (V1/2), or a totally replaced lymph node (N1/2). Replaced nodes should be counted separately as positive nodes in the N category, whereas discontinuous spread or venous invasion should be classified and counted in the site-specific factor category Tumor Deposits.
    NXRegional lymph nodes cannot be assessed.
    N0No regional lymph node metastasis.
    N1Metastases in 1–3 regional lymph nodes.
    N1aMetastasis in 1 regional lymph node.
    N1bMetastases in 2–3 regional lymph nodes.
    N1cTumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastases.
    N2Metastases in ≥4 regional lymph nodes.
    N2aMetastases in 4–6 regional lymph nodes.
    N2bMetastases in ≥7 regional lymph nodes.

    Table 3. Distant Metastasis (M)a

    a 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.
    M0No distant metastasis.
    M1Distant metastasis.
    M1aMetastasis confined to 1organ or site (e.g., liver, lung, ovary, nonregional node).
    M1bMetastases in >1 organ/site or the peritoneum.

    Table 4. Anatomic Stage/Prognostic Groupsa,b

    StageTNMDukescMACc
    a 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.
    b cTNM is the clinical classification, and pTNM is the pathologic classification. The y prefix is used for those cancers that are classified after neoadjuvant pretreatment (e.g., ypTNM). Patients who have a complete pathologic response (ypT0, N0, cM0) may be similar to stage group 0 or I. The r prefix is to be used for those cancers that have recurred after a disease-free interval (rTNM).
    c Dukes B is a composite of better (T3, N0, M0) and worse (T4, N0, M0) prognostic groups, as is Dukes C (any T, N1, M0 and any T, N2, M0). MAC is the modified Astler-Coller classification.
    0TisN0M0----
    IT1N0M0AA
     T2N0M0AB1
    IIAT3N0M0BB2
    IIBT4aN0M0BB2
    IICT4bN0M0BB3
    IIIAT1–T2N1/N1cM0CC1
     T1N2aM0CC1
    IIIBT3–T4aN1/N1cM0CC2
     T2–T3N2aM0CC1/C2
     T1–T2N2bM0CC1
    IIICT4aN2aM0CC2
     T3–T4aN2bM0CC2
     T4bN1–N2M0CC3
    IVAAny TAny NM1a----
    IVBAny TAny NM1b----
    1|2|3|4

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