Staging for Colon and rectal cancer
Staging for colon cancer
Staging is the term given to the investigations which are undertaken before surgery and the assessment of the pathology specimen after surgery, to determine the extent of a cancer. In particular it is important to know if the cancer has already spread from its primary site, within the colon, to the lymph glands or another organs such as the Liver or the Lungs. Cancers which are detected by screening for bowel cancer are more likely to be of an earlier (better) stage.
Surgery for early colon and rectal cancer has an excellent survival with more than 93% of patients surviving 5 years. Unfortunately those presenting with advanced disease of a much poorer survival to 5 years of only 6.6%. There are a number of staging systems is place which can be used to help patients and doctors understand the significance of their disease.
The Dukes Classification is one of the best understood systems
|Dukes stage||Local spread||Lymphnodes involved||Distant metastases||5 year survival|
|A||Lining of the bowel||No||No||93%|
|B||Through the muscular wall of the bowel||No||No||77%|
|C||Any involvement of the wall||Nodes involved||No||47%|
|D||Any involvement of the wall||Any nodal status||Yes||6.6%|
The objective of staging is as far as possible to detect all of the cancer present and use this information, to decide on the most appropriate treatment, to offer the best survival with the least risk of recurrence. The staging investigations may include;
CT scanning; looking for nodal disease, local and distal spread.
MRI scanning in rectal cancer; looking for local spread and nodal disease.
Colonoscopy; to obtain a pathology specimen, to look for polyps and second cancers.
PET CT scanning; to look for nodal disease and distant metastases
Endo anal ultrasound scanning; to look for local spread in polyps and early rectal cancers.
Once the required investigations have been completed every cancer case is discussed at a Multi Diciplinary Team (MDT) meeting. This meeting includes a Surgeon, Radiologist, Pathologist, Oncologist and Medical Gastroenterologist. The meeting will review the options for each patient so that the patient can agree a treatment plan with their surgeon. Mr Miles is a core member of the Worthing Colorectal MDT.
Each Patient is discussed at a number of stages during their treatment this pathway is published by the Sussex Cancer Network, you can download it here.
Surgery with an intention to cure
Preoperative chemo / radio therapy with an intention to reduce the tumour load before surgery
Palliative surgery with an intention to relieve the symptoms of an irresectable tumour load.
Second stage surgery to removed metastatic disease.