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Clinicopathological staging of cancer

  • Staging is the clinical or pathological assessment of the extent of tumour spread
  • Clinical staging is a preoperative assessment
  • It is based on clinical, radiological and operative information
  • Used to determine treatment offered to the patient
  • Pathological staging is a postoperative assessment
  • Provides useful prognostic information
  • Allows decisions to be made regarding adjuvant therapy
  • Allows comparison of treatment outcomes between different centres

Staging systems

  • The ideal staging system should be:
    • Easy to use and remember
    • Reproducible - not subject to inter or intra-observer variation
    • Based on prognostically important pathological factors

TNM system>/h4>

  • Based on anatomical extent of spread
    • T refers to the extent of primary tumour
    • N refers to the extent of nodal metastases
    • M refers to the presence or absence of distant metastases
  • Two classifications are described for each site
    • Clinical classification (TNM)
    • Pathological classification (pTNM)
T - primary tumour
Tx  primary tumour can not be assessed
To no evidence of primary tumour
Tis carcinoma in-situ
T1-4 increasing size and local extent of primary tumour
N - regional lymph nodes
Nx  regional lymph nodes can not be assessed
N0 no regional lymph node metastases
N1-3 increasing involvement of regional lymph nodes
M - distant metastases
Mx distant metastases can not be assessed
M0  no distant metastases
M1 distant metastases present
  • The TNM system is generally accepted
  • Does not recorded all factors (e.g. grade, contiguous organ involvement) that is prognostically important

Dukes staging of colorectal cancer

  • First published in 1932 for rectal cancers
  • Now used for all rectal and colonic cancers

Duke's stageing og colorectal cancers

  • Duke's A - spread into submucosa but not through muscle
  • Duke's B - spread through muscle but nodes negative
  • Duke's C - lymph node metastases present
  • Often divided into C1 and C2 dependent on the involvement of the highest lymph node
  • Advantages of the Dukes classification are that it
  • Is simple and reproducible
  • Accurately reflects prognosis
  • Accepted nationally and internationally


Sobin L H.  TNM:  principles, history and relation to other prognostic factors.  Cancer 2001;  91 (Suppl 8):  S1589-1592.

Yarbro J W,  Page D L,  Fielding L P,  Partridge E E,  Murphy G P.  American Joint Committee on Cancer prognostic factors consensus conference.  Cancer 1999;  86:  2436-2446.



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