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Colorectal Cancer Staging: TNM Classification of Colorectal Cancer

Colorectal cancer staging helps to determine the disease prognosis and to select an appropriate treatment strategy.

TNM is the most commonly used staging system for colorectal cancer. It uses mainly 3 parameters: “T” stands for “Tumor”; “N” for “Lymph Nodes”; and “M” for “Metastasis”. Numbers and/or letters after T (0, is, 1, 2, 3, and 4), N (0, 1, and 2), and M (0 and 1) provide more details about each of these parameters. Once T, N, and M are determined, it is used to assign an overall stage (from 0 to IV).

Colorectal Cancer - T Staging - Infographic
Colorectal Cancer - T Staging
Colorectal Cancer - N and M Staging - Infographic
Colorectal Cancer - N and M Staging

Following table describes the detailed TNM staging for colorectal cancer.

STAGE TNM DESCRIPTION
0 Tis N0 M0 Pre-cancerous or cancer cells present only in the superficial layer (epithelium) of colorectal mucosa
I T1-2 N0 M0 Cancer extends to the lamina propria or muscular layer (muscularis propria) without spread to regional lymph nodes or distant sites.
IIA T3 N0 M0 Cancer extends through the muscularis propria into the pericolorectal tissues without spread to regional lymph nodes or distant sites.
IIB T4a N0 M0 Cancer has invaded up to the outermost serosa layer (or visceral peritoneum) without spread to regional lymph nodes or distant sites.
IIC T4b N0 M0 Cancer has invaded into the adjacent structures/organs like small intestine, kidneys, pancreas, or stomach without spread to regional lymph nodes or distant sites.
IIIA T1-2 N1/1c M0 Cancer has invaded up to the muscular layer and has spread to 1 to 3 nearby lymph nodes/no lymph node but only the fat around lymph nodes.
OR
T1 N2a M0 Cancer has invaded up to the submucosa layer and has spread to 4 to 6 nearby lymph nodes.
IIIB T3-4a N1/1c M0 Cancer has invaded up to the outermost serosa layer (or visceral peritoneum) and has spread to 1 to 3 nearby lymph nodes/no lymph node but only the fat around lymph nodes.
OR
T2-3 N2a M0 Cancer has invaded into the muscularis propria or pericolorectal tissue and has spread to 4 to 6 nearby lymph nodes.
OR
T1-2 N2b M0 Cancer has invaded up to the muscularis propria and has spread to >/=7 nearby lymph nodes.
IIIC T4a N2a M0 Cancer has invaded up to the outermost serosa layer (or visceral peritoneum) and has affected 4 to 6 nearby lymph nodes.
OR
T3-4a N2b M0 Cancer has invaded into pericolorectal tissues or serosa and has spread to >/=7 nearby lymph nodes.
OR
T4b N1-2 M0 Cancer has invaded into the adjacent organs/structures and has affected 1 to 4 nearby lymph nodes.
IVA Any T Any N M1a Cancer has spread to one distant organ without peritoneal spread.
IVB Any T Any N M1b Cancer that has spread to >/=2 distant organs without peritoneal spread.
IVC Any T Any N M1c Cancer that has spread to peritoneum with or without other sites.

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Watch the video below to know the NORMAL ANATOMY that will help to understand the staging better.

Following video explains in detail the TNM STAGING FOR COLON CANCER in an easy to understand manner.

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