Colon Cancer Staging

Staging Colorectal Cancer

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Colon cancer is the second leading cause of cancer deaths in the United States. In 1999 there were approximately 130,000 new cases of colorectal cancer with an estimated 56,600 deaths. For reference purposes, deaths from lung cancer were over 160,000. Fortunately, colon cancer is highly treatable IF it is caught in the early stages. Unfortunately, it is often not symptomatic until it has progressed into a more advanced stage. This is why screening is so important, and why screening is so highly recommended as we pass the age of 50. Actually the greatest risk factor for colon cancer is age. This is well illustrated by a graph at this CDC site (http://www.cdc.gov/cancer/colorctl/colorect.htm). Rates of colorectal cancer rise from 10 per 100,000 at age 40-45 to 300 per 100,000 at age 75-80. Take the advice: get screened after age 50, or younger if you are in a high-risk group.

About 90% of colorectal cancers are thought to arise from polyps (Dollinger, 1997). Polyps may look like a wart when small, and like a cherry on a stem when larger. Usually polyps are benign, but left untreated (not removed), become more likely to develop into cancer over time. Specifically, the chances of a polyp becoming cancerous are 2.5% in 5 years and over 24% over 20 years. (Mansell, 1999). Once again, we see the value of early screening and removal of polyps.

Cancer that does begin in the colon or rectum is assigned a "stage" by physicians. The earlier the stage of the cancer, the greater the chance of survival. Unfortunately, following the staging can get a little confusing because at least two different methods are often employed. The first, and oldest, is the Duke's classification system. The Duke's system uses four stages lettered A, B, C, D. Another method, in fact the one recommended by the American Joint Commission on Cancer, is called the TNM staging system. This system uses four stages I, II, III, IV which correspond to the Duke system, but each stage is further broken down to reflect more detailed information. "T" is used to describe the size and extent of the main tumor (1-4). The higher the number, the more invasive the tumor. "N" is used to describe whether lymph nodes are involved, and how many. "M" is used to describe the degree of metastases to other parts of the body. M0 means there is no metastases. The following chart summarizes the staging systems.

STAGE	TNM	GROUP	GROUP	DUKE’S
Stage I	T1	N0	M0	Duke’s A
	T2	N0	M0

Stage II	T3	N0	M0	Duke’s B
	T4	N0	M0

Stage III	any T	N1	M0	Duke’s C
	any T	N2, N3	M0

Stage IV	any T	any N	M1	Duke’s D

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