How are pediatric colorectal tumors staged?

Updated: Jun 06, 2020
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Cameron K Tebbi, MD  more...
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In 1932, Cuthbert Esquire Dukes, the Director of the Research Laboratory at St. Mark's Hospital in London, indicated that growth of colorectal cancers followed an orderly and predictable fashion. He created a staging classification system that was later modified in 1954 by Astler and Coller. [63]  The extent of the disease is determined using the modified Dukes staging scheme. According to this classification, in stage A, only the mucosa and submucosa are affected; in stage B, the disease is limited to the bowel wall; in stage C, the disease is limited to the lymph nodes; and in stage D, the patient has distant metastases, peritoneal implants, direct invasion of other viscera, or surgically unresectable tumors.

The American Joint Committee on Cancer (AJCC) published the most commonly used system to evaluate prognosis in colorectal cancer. [64]  The AJCC TNM staging of colorectal cancer is described in the following table.

Table 1. American Joint Committee on Cancer TNM Staging of Colorectal Cancer (Open Table in a new window)

Primary Tumor (T)

Nodal Involvement (N)

Distant Metastasis (M)

TX: Primary tumor cannot be assessed.

Nx: Regional lymph nodes cannot be assessed.

MX: Presence of distant metastasis cannot be assessed.

T0: No evidence of primary tumor is present.

N0: No evidence of regional lymph node metastases is present.

M0: No evidence of distant metastasis is observed.

Tis: Carcinoma in situ is present.

N1A: Metastasis in 1 pericolic or perirectal lymph node is present.

M1A: Distant metastasis is present in a single organ.

T1: Tumor cells invade the submucosa

N1B: Metastasis in 2-3 pericolic or perirectal lymph nodes is present.

M1B: Distant metastasis is present in multiple organs.

T2: Tumor cells invade the muscularis propria.

N1C: Metastasis in subserosa, mesentery, or nonperitonealized pericolic or perirectal tissue without lymph node metastasis.


T3: Tumor cells invade the muscularis propria into nonperitonealized pericolic or perirectal tissues.

N2A: Metastasis in 4-6 pericolic or perirectal lymph nodes.


T4A: Tumor cells perforate the visceral peritoneum.

N2B: Metastasis in 7 or more pericolic or perirectal lymph nodes is observed.


T4B: Tumor cells directly invade and adhere to other organs and structures.



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