Σταδιοποίηση σε Ca Παχέως Εντέρου

Ca Παχέως Εντέρου

AJCC Stages

Stages

T

N

M

Dukes¹

MAC²

0

Tis

N0

M0

-

-

I

T1

N0

M0

A

A

T2

N0

M0

A

B1

IIA

T3

N0

M0

B

B2

IIB

T4a

N0

M0

B

B2

IIC

T4b

N0

M0

B

B3

IIIA

T1-T2

N1/N1c

M0

C

C1

T1

N2a

M0

C

C1

IIIB

T3-T4a

N1/N1c

M0

C

C2

T2-T3

N2a

M0

C

C1/C2

T1-T2

N2b

M0

C

C1

IIIC

T4a

N2a

M0

C

C2

T3-T4a

N2b

M0

C

C2

T4b

N1-N2

M0

C

C3

IVA

Any T

Any N

M1a

D

D

IVB

Any T

Any N

M1b

D

D

¹Dukes B is a composite of better (T3 N0 M0) and worse (T4 N0 M0) prognostic groups, as is Dukes C (Any T N1 M0 and Any T N2 M0). 
²MAC is the modified Astler-Coller classification. Description of MAC: B1 is defined as invasion into the muscularis propria without nodal disease; B2 is invasion into the perirectal or pericolic fat without nodal disease; B3 represents involvement of adjacent structures; C1 is B1 with nodal disease; C2 is B2 with nodal disease; and C3 is B3 with nodal metastasis.

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ: Intraepithelial or invasion of lamina propria¹

T1

Tumor invades submucosa

T2

Tumor invades muscularis propria

T3

Tumor invades through muscularis propria into perirectal tissues

T4a

Tumor penetrates to surface of visceral peritoneum²

T4b

Tumor directly invades or is adherent to other organs or structures²,³

TX

Primary tumor cannot be assessed

¹Tis includes cancer cells confined within the glandular basement membrane (intraepithelial) or mucosal lamina propria (intramucosal) with no extension through the muscularis mucosae into the submucosa. 
²Direct 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 (i.e., 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). 
³Tumor 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 classifications should be used to identify the presence or absence of vascular or lymphatic invasion, whereas the PN site-specific factor should be used for perineural invasion.

(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

N1a

Metastasis in 1 regional lymph node

N1b

Metastasis in 2-3 regional lymph nodes

N1c

Tumor deposit(s) in subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastasis

N2

Metastasis in ≥ 4 regional lymph nodes

N2a

Metastasis in 4-6 regional lymph nodes

N2b

Metastasis in ≥ 7 lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

M1a

Metastasis confined to 1 organ or site (e.g., liver, lung, ovary, nonregional node)

M1b

Metastases in > 1 organ/site or the peritoneum

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

*G1-G2 can be designated low grade. G3-G4 as high grade may contribute to overall outcome independent of TNM staging.

Χαρακτηριστικά Επέκτασης

  Local

• Contiguous invasion of adjacent organs
  • Retroperitoneal invasion
    • Posterior walls of ascending and descending colon are retroperitoneal
    • Upper 1/3 of rectum is covered by peritoneum anteriorly and laterally
    • Middle 1/3 of rectum is covered by peritoneum only anteriorly
    • Lower 1/3 of rectum is not covered by peritoneum
  • Ileum
  • Stomach
  • Bladder
  • Prostate
• Peritoneal spread
  • Ascending and descending colon are covered by visceral peritoneum anteriorly
  • Transverse colon is suspended by transverse mesocolon
  • Sigmoid and cecum are peritonealized
  • Peritoneal spread to ovaries (Krukenberg Ca)

  Lymphatic

• 20% of patients have metastatic disease to lymph nodes at presentation
• Initially epicolic and paracolic lymph nodes, then to regional nodes along mesenteric vasculature
• Nodes involved by tumor location
  • Cecum
    • Pericolic, anterior and posterior cecal, ileocolic, right colic nodes
  • Ascending colon
    • Pericolic, ileocolic, right colic, middle colic

• Hepatic flexure
  • Pericolic, right colic, middle colic nodes
• Transverse colon
  • Pericolic, middle colic nodes
• Splenic flexure
  • Pericolic, middle colic, left colic, inferior mesenteric nodes
• Descending colon
  • Pericolic, left colic, inferior mesenteric, sigmoid nodes
• Sigmoid colon
  • Pericolic, inferior mesenteric, superior rectal, sigmoidal, sigmoid mesenteric nodes
• Rectosigmoid
  • Pericolic, perirectal, left colic, sigmoid, superior rectal, middle rectal nodes
• Rectum
  • Initial tumor spread to mesorectal lymph nodes
  • Upper 1/3 → superior rectal nodes → inferior mesenteric nodes
  • Middle and lower 1/3 → middle and inferior rectal nodes → internal iliac nodes
  • Other nodes include obturator, median sacral, and, less commonly, external or common iliac nodes
  • Paraaortic and inguinal nodes are nonregional, and involvement of these nodes constitutes M1 (stage IV) disease

Hematogenous

• Common sites include liver, lung, brain, and bone

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Applies only to colorectal carcinomas

• Separate staging system for appendiceal and anal carcinomas
• Specific staging applies to lymphomas, carcinoid tumors, and sarcomas

Histological types

• Adenocarcinoma in situ
  • Synonymous with "high-grade" or "severe dysplasia"
• Adenocarcinoma (90%)

• Medullary carcinoma
• Signet ring cell carcinoma
  • > 50% signet ring cells
• Mucinous (colloid type)
  • > 50% mucinous carcinoma
• Others (10%)
  • Squamous cell (epidermoid)
  • Adenosquamous
  • Small (oat cell) carcinoma
  • Undifferentiated
  • Carcinoma, NOS