Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Colorectal Cancer
Paul Finan
• Determination of treatment
A C
B
Staging of Colorectal Cancer
Fitzgerald 1982
“Modified” Dukes‟ Classification
• Introduction of stage D
0 Tis N0 M0
I T1-2 N0 M0
II T3-4 N0 M0
III Any T N1-2 M0
IV Any T Any N M1
Staging of Colorectal Cancer
Stage T N M
I T1-2 N0 M0
IIA T3 N0 M0
IIB T4 N0 M0
III A T1-2 N1 M0
IIIB T3-4 N1 M0
IIIC Any T N2 M0
Staging of Colorectal Cancer
TNM Staging
• Clinical TNM
• Pathological TNM
•Major
advances with
rectal cancer
•Less accuracy
with colonic
cancers
uT1
SM
DM
Solitary hepatic
metastasis
Staging of Colorectal Cancer
Problems with Clinical TNM
• Involvement of RCR
Staging of Colorectal Cancer
Problems with Pathological TNM
Quirke et al 2007
Staging of Colorectal Cancer
Problems with Pathological TNM
De-duplication
English cancer
registry information
A B
A
Linked national
dataset
Hospital
Episode C
Statistics
C D
De-duplication
Staging fields requested in the NCDR
• Clinical T stage • Dukes‟ stage
• Clinical N stage • Metastases at diagnosis
• Clinical M stage • Number of nodes examined
• Combined clinical TNM stage • Number of positive nodes
• Pathological T stage • Tumour size
• Pathological N stage • TNM version
• Pathological M stage • Neo-adjuvant treatment flag
• Combined pathological TNM
stage • Nottingham prognostic index
• Integrated T stage • Breslow thickness
• Gleason score
• Integrated; N stage
• FIGO score
• Integrated M stage
• Combined integrated TNM
stage
Rules used to derive stage across the multiple
staging fields in the NCDR
• The information in each staging field was „cleaned‟ to
ensure only valid staging information was present
ECRIC X X
NWCIS X X X
NYCRIS X
OCIU X X X
SWCIS X X X
ThCR X X X
TrCR X X
WMCIU x x x X
Percentage distribution of Dukes Stage
between 1995 - 2008
Cancer Dukes‟ Stage
Registry A B C D Unknown
ECRIC 9.1 20.0 22.4 12.1 36.3
NWCIS 6.6 20.7 22.4 2.2 48.1
NYCRIS 9.6 22.8 20.4 21.1 26.1
OCIU 9.2 24.1 24.3 12.0 30.4
SWCIS 7.9 21.8 21.1 6.5 42.7
ThCR 6.7 21.0 19.4 20.2 32.7
TrCR 6.8 16.3 16.6 5.7 54.5
WMCIU 9.2 26.2 24.6 14.5 25.6
Total 8.0 21.5 21.1 12.2 37.2
Percentage distribution of Dukes Stage in
2008
Cancer Dukes‟ Stage
Registry A B C D Unknown
ECRIC 12.6 22.7 21.6 15.8 27.3
NWCIS 9.0 20.5 25.0 4.1 41.4
NYCRIS 8.9 20.6 19.6 22.2 28.6
OCIU 9.1 21.4 22.3 5.0 42.1
SWCIS 11.2 22.6 22.5 15.5 28.2
ThCR 9.1 23.0 22.0 19.6 26.3
TrCR 12.7 21.4 22.3 7.6 36.0
WMCIU 11.1 25.6 24.4 15.9 23.0
Total 10.4 22.3 22.5 14.3 30.6
Staging of Colorectal Cancer
Proposal from NYCRIS