Staging: Rectal Cancer (All Stages)
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The staging system the medical community uses is the TNM system:
- T for tumor indicates the depth of invasion of the tumor. T is determined when the tumor is removed and sent to the pathologist.
- N for nodes indicates the presence of cancer cells in the lymph nodes. Lymph nodes are checked for tumor spread at the time of surgery.
- M for metastasis indicates spread of the cancer to other organs. M is determined with x-rays, scans and blood tests.
- For more information about staging in general, click here.
Following are the basic stages of rectal cancer.
Stage 0: Tis, N0, M0
The earliest possible stage. Cancer has not moved from where it started. It is still only in the innermost lining of the colon wall (the mucosa). These abnormal cells may become cancer and spread into nearby tissue. Stage 0 is sometimes referred to as “Carcinoma In Situ”
Stage I T1, N0, M0; T2 N0, M0
In stage I, the cancer has begun to spread, but is still only in the inner lining of the colon. The cancer has spread beyond the innermost tissue layer of the colon wall to the middle layers which are known as submucosa (the layer of tissue under the mucosa). Stage 1 is also known as “Dukes A Colorectal Cancer”.
Stage II
In stage II, the cancer has not spread to lymph nodes but may have spread to nearby organs. Colon Cancer is divided into stages IIA, IIB and IIC. Stage II is also known as “Dukes B Colorectal Cancer”.
- Stage IIA: T3, N0, M0: Cancer has spread beyond the middle tissue layers of the colon wall to the outermost layer of the colon wall (the serosa) or has spread to nearby tissues around the colon or rectum.
- Stage IIB: T4a, N0, M0: Cancer has spread beyond the colon wall but has not spread to nearby organs.
- Stage IIC: T4b, N0, M0: Cancer has spread beyond the colon wall outer layer to nearby organs.
Stage III
In stage III, rectal cancer has spread outside the colon to the regional lymph nodes. Rectal cancer is divided into stages IIIA, IIIB and IIIC. Stage III is also known as “Dukes C Colorectal Cancer”.
- Stage IIIA T1-T2, N1, M0
- Cancer may have spread through the innermost layer (the mucosa) of the colon wall to the layer of tissue under the mucosa (the submucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes; or
- Cancer has spread through the innermost layer (the mucosa) of the colon wall to the layer of tissue under the mucosa. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
- Cancer may have spread through the innermost layer (the mucosa) of the colon wall to the layer of tissue
- Stage IIIB T3-T4a, N1, M0 or T2-T3, N2a, M0 or T1-T2, N2b, M0
- Cancer has spread through the muscle layer of the colon wall to the outermost layer (the serosa) of the colon wall or has spread through the serosa but not to nearby organs . Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes; or
- Cancer has spread to the muscle layer of the colon wall or to the outmost layer (the serosa) of the colon wall. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the innermost layer of the colon wall (the mucosa) to the layer of tissue under the mucosa (the submucosa)) and may have spread to the muscle layer of the colon wall. Cancer has spread to 7 or more nearby lymph nodes.
- Cancer has spread through the muscle layer of the colon
- Stage IIIC T4a, N2a, M0 or T3-T4a, N2b, M0, or T4b, N1-N2, M0
- Cancer has spread through the outermost layer of the colon wall (the serosa) but has not spread to nearby organs . Cancer has spread to at least 4 but not more than 6 nearby lymph nodes ; or
- Cancer has spread through the muscle layer of the colon wall to the outmost layer of the colon wall (the serosa) or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes; or
- Cancer has spread through the outermost layer of the colon wall (the serosa)and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes.
Image countesy of National Cancer Institute
- Cancer
Stage IV
The cancer has spread through the lymph system or blood stream to distant parts of the body. This is known as metastasis. The most likely organs to experience metastasis from colon cancer are the liver and then the lung. Stage IV is also known as “Dukes D Colorectal Cancer.” Stage IV rectal cancer is divided into stage IVA and stage IVB.
Stage IVA: any T, any N, M1a: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes . Cancer has spread to one organ that is not near the colon, such as the liver , lung , or ovary , or to a distant lymph node.
Stage IVB: any T, any N, M1b: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes . Cancer has spread to more than one organ that is not near the colon or into the lining of the abdominal wall.
For additional information about staging, see the American Joint Committee on Cancer (AJCC) staging information at: http://www.cancerstaging.org/staging/index.html .
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