Editing Colon cancer (section)

== '''Staging''' ==

** Poor prognostic indicators not captured by TNM staging
*** High CEA
*** Tumour deposits within the lymph drainage area of a cancer
*** Lymphovascular and perineural invasion
*** Histologic grade
*** Mucinous and signet ring adenocarcinomas
** '''Pathological staging - Colorectal cancer TNM staging AJCC UICC 8th edition'''

{| class="wikitable"
|'''Primary tumor (T)'''
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|'''T category'''
|'''T criteria'''
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|TX
|Primary tumor cannot be assessed
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|T0
|No evidence of primary tumor
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|Tis
|Carcinoma ''in situ'', intramucosal carcinoma (involvement of lamina propria with no extension through muscularis mucosae)
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|T1
|Tumor invades the submucosa (through the muscularis mucosa but not into the muscularis propria)
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|T2
|Tumor invades the muscularis propria
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|T3
|Tumor invades through the muscularis propria into pericolorectal tissues
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|T4
|Tumor invades* the visceral peritoneum or invades or adheres¶ to adjacent organ or structure
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|T4a
|Tumor invades* through the visceral peritoneum (including gross perforation of the bowel through tumor and continuous invasion of tumor through areas of inflammation to the surface of the visceral peritoneum)
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|T4b
|Tumor directly invades* or adheres¶ to adjacent organs or structures
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|* Direct invasion in T4 includes invasion of other organs or other segments of the colorectum as a result of direct extension through the serosa, as confirmed on microscopic examination (for example, invasion of the sigmoid colon by a carcinoma of the cecum) or, for cancers in a retroperitoneal or subperitoneal location, direct invasion of other organs or structures by virtue of extension beyond the muscularis propria (ie, respectively, a tumor on the posterior wall of the descending colon invading the left kidney or lateral abdominal wall; or a mid or distal rectal cancer with invasion of prostate, seminal vesicles, cervix, or vagina).

¶ Tumor that is adherent to other organs or structures, grossly, is classified cT4b. However, if no tumor is present in the adhesion, microscopically, the classification should be pT1-4a depending on the anatomical depth of wall invasion. The V and L classification should be used to identify the presence or absence of vascular or lymphatic invasion whereas the PN prognostic factor should be used for perineural invasion.
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|'''Regional lymph nodes (N)'''
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|'''N category'''
|'''N criteria'''
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|NX
|Regional lymph nodes cannot be assessed
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|N0
|No regional lymph node metastasis
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|N1
|One to three regional lymph nodes are positive (tumor in lymph nodes measuring ≥0.2 mm), or any number of tumor deposits are present and all identifiable lymph nodes are negative
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|N1a
|One regional lymph node is positive
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|N1b
|Two or three regional lymph nodes are positive
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|N1c
|No regional lymph nodes are positive, but there are tumor deposits in the:

·       Subserosa

·       Mesentery

·       Nonperitonealized pericolic, or perirectal/mesorectal tissues
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|N2
|Four or more regional nodes are positive
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|N2a
|Four to six regional lymph nodes are positive
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|N2b
|Seven or more regional lymph nodes are positive
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|'''Distant metastasis (M)'''
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|'''M category'''
|'''M criteria'''
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|M0
|No distant metastasis by imaging, etc; no evidence of tumor in distant sites or organs. (This category is not assigned by pathologists.)
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|M1
|Metastasis to one or more distant sites or organs or peritoneal metastasis is identified
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|M1a
|Metastasis to one site or organ is identified without peritoneal metastasis
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|M1b
|Metastasis to two or more sites or organs is identified without peritoneal metastasis
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|M1c
|Metastasis to the peritoneal surface is identified alone or with other site or organ metastases
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|'''Prognostic stage groups'''
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|'''When T is...'''
|'''And N is...'''
|'''And M is...'''
|'''Then the stage group is...'''
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|Tis
|N0
|M0
|0
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|T1, T2
|N0
|M0
|I
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|T3
|N0
|M0
|IIA
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|T4a
|N0
|M0
|IIB
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|T4b
|N0
|M0
|IIC
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|T1-T2
|N1/N1c
|M0
|IIIA
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|T1
|N2a
|M0
|IIIA
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|T3-T4a
|N1/N1c
|M0
|IIIB
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|T2-T3
|N2a
|M0
|IIIB
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|T1-T2
|N2b
|M0
|IIIB
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|T4a
|N2a
|M0
|IIIC
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|T3-T4a
|N2b
|M0
|IIIC
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|T4b
|N1-N2
|M0
|IIIC
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|Any T
|Any N
|M1a
|IVA
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|Any T
|Any N
|M1b
|IVB
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|Any T
|Any N
|M1c
|IVC
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