Σταδιοποίηση σε Ca Πρωκτού

 

Ca Πρωκτού

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

T3

N0

M0

IIIA

T1

N1

M0

T2

N1

M0

T3

N1

M0

T4

N0

M0

IIIB

T4

N1

M0

Any T

N2

M0

Any T

N3

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 (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III [AIN II-III])

T1

Tumor ≤ 2 cm in greatest dimension

T2

Tumor > 2 cm but ≤ 5 cm in greatest dimension

T3

Tumor > 5 cm in greatest dimension

T4

Tumor of any size invading adjacent organ(s), e.g., vagina, urethra, bladder*

*Direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, sphincter muscle(s) is not classified as T4.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in perirectal lymph node(s)

N2

Metastasis in unilateral internal iliac &/or inguinal lymph node(s)

N3

Metastasis in perirectal and inguinal lymph nodes &/or bilateral internal iliac &/or inguinal lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

  • Local spread can occur to adjacent structures, including vagina, urethra, and urinary bladder

Nodal spread

  • Metastatic spread to regional lymph nodes represents most common mode of tumor spread
  • Lymphatic drainage depends on location of tumor in relation to dentate line
    • Tumors below dentate line → inguinal and femoral nodes
  • Tumors above dentate line → perirectal and paravertebral nodes
    • Similar to rectal cancers
  • Regional nodes are inguinal, internal iliac, and perirectal (anorectal, perirectal, and lateral sacral) nodes
  • Incidence of nodal metastasis ~ 10% at diagnosis
    • May be as high as 20–60% for T4 lesions

Distant metastases

  • Occur in ~ 10% of cases of anal carcinoma
  • Mainly to liver and lungs

Κατηγοριοποίηση (Ιστολογικοί Τύποι)
  • Squamous cell carcinomas (SCC) make up majority of all primary anal carcinomas (80% of anal canal tumors)
    • Cloacogenic (basaloid or transitional cell) are considered variants of SCC
      • Exhibit similar natural history, response to treatment, and prognosis
      • All are associated with human papilloma virus (HPV) infection
  • Adenocarcinomas (10%)
    • Rectal type
    • Adenocarcinomas of anal glands
    • Adenocarcinomas within anorectal fistula
  • Mucinous adenocarcinoma
  • Small cell carcinoma
  • Undifferentiated carcinoma