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Colon and Rectum

Sarcomas, lymphomas, and carcinoid tumors of the large intestine or appendix are not included

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Book cover AJCC Cancer Staging Manual

Summary of Changes

A revised description of the anatomy of the colon and rectum better delineates the data concerning the boundaries between colon, rectum, and anal canal. Adenocarcinomas of the vermiform appendix are classified according to the TNM staging system but should be recorded separately, whereas cancers that occur in the anal canal are staged according to the classification used for the anus.

Smooth metastatic nodules in the pericolic or perirectal fat are considered lymph node metastases and will be counted in the N staging. In contrast, irregularly contoured metastatic nodules in the peritumoral fat are considered vascular invasion and will be coded as an extension of the T category as either a VI (microscopic vascular invasion) if only microscopically visible or a V2 (macroscopic vascular invasion) if grossly visible.

Stage Group II is subdivided into IIA and IIB on the basis of whether the primary tumor is T3 or T4, respectively.

Stage Group III is subdivided into IIIA (T1–2N1M0), HIB (T3–4N1M0)

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Bibliography

  • Adam IJ, Mohamdee MO, Martin IG, et al: Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711, 1994

    Article  PubMed  CAS  Google Scholar 

  • Astler VB, Coller FA: The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139:846–852, 1954

    Article  PubMed  CAS  Google Scholar 

  • Bast RC, Desch CE, Ravdin P, et al: Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer: report of the American Society of Clinical Oncology Expert Panel. J Clin Oncol 14:2843–2877, 1996

    Google Scholar 

  • Bauer K, Bagwell C, Giaretti W, et al: Consensus review of the clinical utility of DNA flow cytometry in colorectal cancer. Cytometry 14:486–491, 1993

    Article  PubMed  CAS  Google Scholar 

  • Belluco C, Esposito G, Bertorelle R, et al: Absence of the cell cycle inhibitor p27Kipl protein predicts poor outcome in patients with stage I—III colorectal cancer. Ann Surg Oncol 6:19–25, 1999

    Article  PubMed  CAS  Google Scholar 

  • Belluco C, Frantz M, Carnio S, et al: IL-6 blood level is associated with circulating CEA and prognosis in patients with colorectal cancer. Ann Surg Oncol 7:133–138, 2000

    Article  PubMed  CAS  Google Scholar 

  • Butch RJ, Stark DD, Wittenberg J, et al: Staging rectal cancer by MR and CT. Am J Roentgenol 146:1155–1160, 1986

    Article  CAS  Google Scholar 

  • Caplin S, Cerottini JP, Bosman FT, et al: For patients with Dukes’ B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer 83:666–672, 1998

    Article  PubMed  CAS  Google Scholar 

  • Chapuis PH, Fisher R, Dent DF, et al: The relationship between different staging methods and survival in colorectal carcinoma. Dis Colon Rectum 28:158–161, 1985

    Article  PubMed  CAS  Google Scholar 

  • Coia LR, Gunderson LL, Haller D, et al: Outcomes of patients receiving radiation for carcinoma of the rectum. Results of the 1988–1989 patterns of care study. Cancer 86:1952–1958, 1999

    Article  PubMed  CAS  Google Scholar 

  • Compton CO. Updated protocol for the examination of specimens removed from patients with colorectal carcinoma. Arch Pathol Lab Med 124:1016–1025, 2000

    PubMed  CAS  Google Scholar 

  • Compton CC, Fenoglio-Prieser CM, Pettigrew N, Fielding LP: American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88:1739–1757, 2000

    Article  PubMed  CAS  Google Scholar 

  • Compton CC, Fielding LP, Burgart LJ, et al: Prognostic factors in colorectal cancer: College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994, 2000

    PubMed  CAS  Google Scholar 

  • Copeland EM, Miller LD, Jones RS: Prognostic factors in carcinoma of the colon and rectum. Am J Surg 116:875–881, 1968

    Article  PubMed  CAS  Google Scholar 

  • Dukes CE: Cancer of the rectum: an analysis of 1000 cases. J Pathol Bacteriol 50:527–539, 1940

    Article  Google Scholar 

  • Fenoglio-Preiser CM, Hutter RVP: Colorectal polyps: pathologic diagnosis and clinical significance. Cancer J Clin 35:322–344, 1985

    Article  CAS  Google Scholar 

  • Fielding LP, Arsenault PA, Chapuis PH, et al: Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). Gastroenterol Hepatol 6:325–344, 1991

    Article  CAS  Google Scholar 

  • Fielding LP, Pettigrew N: College of American Pathologists Conference XXVI on clinical relevance of prognostic markers in solid tumors: report of the Colorectal Working Group. Arch Pathol Lab Med 119:1115–1121, 1995

    PubMed  CAS  Google Scholar 

  • Fielding LP, Phillips RK, Frey JS, et al: The prediction of outcome after curative resection for large bowel cancer. Lancet 2:904–907, 1986

    Article  PubMed  CAS  Google Scholar 

  • Fielding LP, Phillips RK, Hittinger R: Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet 1:595–597, 1989

    Article  PubMed  CAS  Google Scholar 

  • Gilbert SG. Symptomatic local tumor failure following abdomino-perineal resection. Int J Radiat Oncol Biol Phys. 4:801–807, 1978

    Article  PubMed  CAS  Google Scholar 

  • Goldstein NS, Turner JR. Pericolonic tumor deposits in patients with T3N + M0 colon adenocarcinomas: a marker for reduced disease-free survival and intra-abdominal metastasis. Cancer 88:2228–2238, 2000

    Article  PubMed  CAS  Google Scholar 

  • Griffin MR, Bergstralh EJ, Coffey RJ, et al: Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 60:2318–2324, 1987

    Article  PubMed  CAS  Google Scholar 

  • Gunderson LL, Sosin H: Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer. 34:1278–1292, 1974

    Article  PubMed  CAS  Google Scholar 

  • Hall NR, Finan PJ, al-Jaberi T, et al: Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent: predictor of survival but not local recurrence? Dis Colon Rectum 41:979–983, 1998

    Article  PubMed  CAS  Google Scholar 

  • Hailing KC, French AJ, McDonnell SK, et al: Microsatellite imbalance in stage B2 and C colorectal cancers. J Natl Cancer Inst 91:1295–1303, 1999

    Article  Google Scholar 

  • Harrison JC, Dean PJ, El-Zeky F, Vander Zwaag R: From Dukes through Jass. Pathological prognostic indicators in rectal cancer. Hum Pathol 25:498–505, 1994

    Article  PubMed  CAS  Google Scholar 

  • Harrison JC, Dean PJ, El-Zeky F, Vander Zwaag R: Impact of the Crohn’s-like lymphoid reaction on staging of right-sided colon cancer: results of a multivariate analysis. Hum Pathol 26:31–38, 1995

    Article  PubMed  CAS  Google Scholar 

  • Hermanek P: Colorectal carcinoma. Histopathological diagnosis and staging. Baillieres Clin Gastroenterol 3:511–529, 1989

    Article  PubMed  CAS  Google Scholar 

  • Hermanek P: Problems of pTNM classification of carcinoma of the stomach, colorectum and anal margin. Pathol Res Pract 181:296–300, 1986

    Article  PubMed  CAS  Google Scholar 

  • Hermanek P, Gall FP: Early (microinvasive) colorectal carcinoma: pathology, diagnosis, surgical treatment. Int J Colorectal Dis 1:79–84, 1986

    Article  PubMed  CAS  Google Scholar 

  • Hermanek P, Giedl J, Dworak O: Two programs for examination of regional lymph nodes in colorectal carcinoma with regard to the new pN classification. Pathol Res Pract 185:867–873, 1989

    Article  PubMed  CAS  Google Scholar 

  • Hermanek P, Guggenmoos-Holzmann I, Gall FP: Prognostic factors in rectal carcinoma: a contribution to the further development of tumor classification. Dis Colon Rectum 32:593–599, 1989

    Article  PubMed  CAS  Google Scholar 

  • Hermanek P, Henson DE, Hutter RVP, Sobin LH: TNM Supplement 1993: A commentary on uniform use. Berlin: Springer-Verlag, 1993

    Google Scholar 

  • Hermanek P, Sobin LH: Colorectal carcinoma. In Hermanek P, Gospodarowicz MK, Henson DE, et al (Eds.): Prognostic factors in cancer. Berlin: Springer-Verlag, 1995

    Chapter  Google Scholar 

  • Herrera-Ornelas L, Justiniano J, Castillo N, et al: Metastases in small lymph nodes from colon cancer. Arch Surg 122:1253–1256, 1987

    Article  PubMed  CAS  Google Scholar 

  • Hoskins RB, Gunderson LL, Dosoretz DE, et al: Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid. Cancer 55:61–71, 1985

    Article  PubMed  CAS  Google Scholar 

  • Jass JR, Atkin WS, Cuzick J, et al: The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 10:437–459, 1986

    Article  PubMed  CAS  Google Scholar 

  • Jass JR, Love SB, Northover JMA: A new prognostic classification of rectal cancer. Lancet 1:1303–1306, 1987

    Article  PubMed  CAS  Google Scholar 

  • Jass JR, Mukawa K, Goh HS, et al: Clinical importance of DNA content in rectal cancer measured by flow cytometry. J Clin Pathol 42:254–259, 1989

    Article  PubMed  CAS  Google Scholar 

  • Jass JR, Sobin LH: Histological typing of intestinal tumours. In WHO international histological classification of tumours, 2nd ed. Berlin-New York: Springer-Verlag, 1989

    Chapter  Google Scholar 

  • Jen J, Kim H, Piantidosi S, et al: Allelic loss of chromosome 18q and prognosis in colorectal cancer. N Eng J Med 331:213–221, 1994

    Article  CAS  Google Scholar 

  • Kokal W, Sheibani K, Terz J, et al: Tumor DNA content in the prognosis of colorectal carcinoma. JAMA 255:3123–3127, 1986

    Article  PubMed  CAS  Google Scholar 

  • Kotanagi H, Fukuoka T, Shibata Y, et al: Blood vessel invasions in metastatic nodes for development of liver metastasis in colorectal cancer. Hepato-Gastroenterol 42:771–774, 1995

    CAS  Google Scholar 

  • Lindmark G, Gerdin B, Sundberg C, et al: Prognostic significance of the microvascular count in colorectal cancer. J Clin Oncol 14:461–466, 1996

    PubMed  CAS  Google Scholar 

  • Lipper S, Kahn LB, Ackerman LV: The significance of microscopic invasive cancer in endoscopically removed polyps of the large bowel: a clinicopathologic study of 51 cases. Cancer 52:1691, 1983

    Article  PubMed  CAS  Google Scholar 

  • Loda M, Cukor B, Tarn SW, et al: Increased proteasome-depen-dent degradation of the cyclin-dependent kinase inhibitor p27 in aggressive colorectal carcinomas. Nature Medicine 3:231–234, 1997

    Article  PubMed  CAS  Google Scholar 

  • Minsky BD, Mies C, Rich TA, et al: Lymphatic vessel invasion is an independent prognostic factor for survival in colorectal cancer. Int J Radiat Oncol 17:311–318, 1989

    Article  CAS  Google Scholar 

  • Newland RC, Chapuis PH, Pheils MT, et al: The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer 47:1424–1429, 1981

    Article  PubMed  CAS  Google Scholar 

  • Ondero H, Maetani S, Nishikawa T, et al: The reappraisal of prognostic classifications for colorectal cancer. Dis Colon Rectum 32:609–614, 1989

    Article  Google Scholar 

  • Phillips RKS, Hittinger R, Blesovsky L, et al: Large bowel cancer: surgical pathology and its relationship to survival. Br J Surg 71:604–610, 1984

    Article  PubMed  CAS  Google Scholar 

  • Pocard M, Panis Y, Malassagne B, et al: Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum 41:839–845, 1998

    Article  PubMed  CAS  Google Scholar 

  • Qizilbash AH: Pathologic studies in colorectal cancer: a guide to the surgical pathology examination of colorectal specimens and review of features of prognostic significance. Pathol Annu 17(1):1–46, 1982

    PubMed  Google Scholar 

  • Ratto C, Sofo L, Ippoliti M, et al: Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significance. Dis Colon Rectum 42:143–154, 1999

    Article  PubMed  CAS  Google Scholar 

  • Rich T, Gunderson LL, Lew R, et al: Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 52:1317–1329, 1983

    Article  PubMed  CAS  Google Scholar 

  • Schild SE, Martenson JA Jr, Gunderson LL, et al: Postoperative adjuvant therapy of rectal cancer: an analysis of disease control, survival, and prognostic factors. Int J Radiat Oncol Biol Phys. 17:55–62, 1989

    Article  PubMed  CAS  Google Scholar 

  • Scott KWM, Grace RH: Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167, 1989

    Article  PubMed  CAS  Google Scholar 

  • Scott NA, Rainwater LM, Wieland HS, et al: The relative prognostic value of flow cytometric DNA analysis and conventional clinicopathologic criteria in patients with operative rectal carcinoma. Dis Colon Rectum 30:513–520, 1987

    Article  PubMed  CAS  Google Scholar 

  • Shepherd NA, Saraga EP, Love SB, et al: Prognostic factors in colonic cancer. Histopathology 14:613–620, 1989

    Article  PubMed  CAS  Google Scholar 

  • Shibata D, Reale MA, Lavin P, et al: The DCC protein and prognosis in colorectal cancer. N Engl J Med 335:1727–1732, 1996

    Article  PubMed  CAS  Google Scholar 

  • Steinberg SM, Barkin JS, Kaplan RS, et al: Prognostic indicators of colon tumors: the gastrointestinal tumor study group experience. Cancer 57:1866–1870, 1986

    Article  PubMed  CAS  Google Scholar 

  • Talbot IC, Ritchie S, Leighton MH, et al: The clinical significance of invasion of veins by rectal cancer. Br J Surg 67:439–442, 1980

    Article  PubMed  CAS  Google Scholar 

  • Talbot IC, Ritchie S, Leighton MH, et al: Spread of rectal cancer within veins: histologic features and clinical significance. Am J Surg 141:15–17, 1981

    Article  PubMed  CAS  Google Scholar 

  • Tepper JE, Cohen AM, Wood WC, et al: Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys 13:5–10, 1987

    Article  PubMed  CAS  Google Scholar 

  • Tepper JE, O’Connell MJ, Niedzwiecki D, et al: Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163, 2001

    PubMed  CAS  Google Scholar 

  • Willett CG, Tepper JE, Kaufman DS, et al: Adjuvant postoperative radiation therapy for rectal adenocarcinoma. Am J Clin Oncol 15:371–375, 1992

    Article  PubMed  CAS  Google Scholar 

  • Williams NS, Durdey P, Qwihe P, et al: Pre-operative staging of rectal neoplasm and its impact on clinical management. Br J Surg 72:868–874, 1985

    Article  PubMed  CAS  Google Scholar 

  • Wolmark N, Fisher B, Wieand HS: The prognostic value of the modifications of the Dukes C class of colorectal cancer: an analysis of the NSABP clinical trials. Ann Surg 203:115–122, 1986

    Article  PubMed  CAS  Google Scholar 

  • Wolmark N, Fisher ER, Wieand HS, et al: The relationship of depth of penetration and tumor size to the number of positive nodes in Dukes C colorectal cancer. Cancer 53:2707–2712, 1984

    Article  PubMed  CAS  Google Scholar 

  • Wong JH, Severino R, Honnebier MB, et al: Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900, 1999

    PubMed  CAS  Google Scholar 

  • Wright CM, Dent OF, Barker M, et al: Prognostic significance of extensive microsatellite instabilty in sporadic clinicopath-ological stage C colorectal cancer. Brit J Surg 87:1197–1202, 2000

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

    Consortia

    American Joint Committee on Cancer

    Editor information

    Editors and Affiliations

    1. Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA

      Frederick L. Greene M.D. (Chair) (Chair)

    2. Vanderbilt University Medical Center, Nashville, Tennessee, USA

      David L. Page M.D. (Professor of Pathology and Epidemiology) (Professor of Pathology and Epidemiology)

    3. Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA

      Irvin D. Fleming M.D. (Professor) (Professor)

    4. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA

      April G. Fritz C.T.R., R.H.I.T.

    5. The Johns Hopkins School of Medicine, Baltimore, Maryland, USA

      Charles M. Balch M.D. (Professor of Surgery and Oncology) (Professor of Surgery and Oncology)

    6. University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA

      Daniel G. Haller M.D. (Professor of Medicine, Associate Chief for Clinical Affairs) (Professor of Medicine, Associate Chief for Clinical Affairs)

    7. Lynn Sage Breast Center, School of Medicine, Northwestern University, Chicago, Illinois, USA

      Monica Morrow M.D. (Professor of Surgery and Director) (Professor of Surgery and Director)

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    American Joint Committee on Cancer. (2002). Colon and Rectum. In: Greene, F.L., et al. AJCC Cancer Staging Manual. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3656-4_12

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    • DOI: https://doi.org/10.1007/978-1-4757-3656-4_12

    • Publisher Name: Springer, New York, NY

    • Print ISBN: 978-3-540-00595-7

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