Σταδιοποίηση σε Ca Λεπτού Εντέρου

Ca Λεπτού Εντέρου

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

T2

N0

M0

IIA

T3

N0

M0

IIB

T4

N0

M0

IIIA

Any T

N1

M0

IIIB

Any T

N2

M0

IV

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

T1a

Tumor invades lamina propria

T1b

Tumor invades submucosa

T2

Tumor invades muscularis propria

T3

Tumor invades through the muscularis propria into the subserosa or into the nonperitonealized perimuscular tissue (mesentery or retroperitoneum) with extension ≤ 2 cm*

T4

Tumor perforates the visceral peritoneum or directly invades other organs or structures (includes other loops of small intestine, mesentery, or retroperitoneum > 2 cm, and abdominal wall by way of serosa; for duodenum only, invasion of pancreas or bile duct)

*The nonperitonealized perimuscular tissue is, for jejunum and ileum, part of the mesentery and, for duodenum in areas where serosa is lacking, part of the interface with the pancreas.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in 1-3 regional lymph nodes

N2

Metastasis in ≥ 4 regional lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Contiguous spread

• Important for primary tumor staging
  • Tumor stage determined by depth of penetration in small bowel wall and invasion of adjacent structures
• Duodenal tumors spread to pancreas, retroperitoneum, and common bile duct
• Jejunal & ileal tumors tend to spread to nonperitonealized perimuscular tissue or mesentery, other small bowel loops, and abdominal wall

Hematogenous spread

• Most commonly to liver

Peritoneal spread

• Usually when tumor violates serosal covering

Lymphatic spread

• Regional nodes depend on location of primary tumor
  • Duodenum
    • Duodenal
    • Hepatic
    • Pancreaticoduodenal
    • Infrapyloric
    • Gastroduodenal
    • Pyloric
    • Superior mesenteric
    • Pericholedochal
  • Ileum and jejunum
    • Superior mesenteric
    • Cecal (terminal ileum only)
      • Ileocolic (terminal ileum only)

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Carcinomas
  • Includes adenocarcinoma and mixed carcinoma/neuroendocrine
• Well-differentiated neuroendocrine tumors
  • Staged separately
• Lymphomas
  • Staged as extranodal lymphomas
• Gastrointestinal stromal tumors
  • Staged separately
• Sarcomas
  • Staged separately
  • Includes leiomyosarcoma, angiosarcoma, liposarcoma

Staging classification does not apply to following tumors

• Well-differentiated neuroendocrine tumors
• Lymphoma
• Carcinoma arising in ileocecal valve
• Carcinoma arising in Meckel diverticulum
• Carcinoma of ampulla of Vater