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Stages of colon and rectal cancer

CT scan showing huge rectal cancer pushing the bladder forwards
CT scan showing huge rectal cancer pushing the bladder forwards

Pre-operative staging will include the proctoscopy (the direct visualisation of the rectum through a telescopic apparatus) or colonoscopy (the same fibre optic telescopic system for the colon) with biopsy and then abdominal scanning, particularly looking for local spread outside the bowel and the liver, and the chest by chest x-ray.


Following operation, which, in this disease, may still go ahead even if there is early evidence of metastatic spread (to forestall bowel obstruction) the most important aspects for staging are given by the pathologist’s report. The pathologist (histologist) will comment on whether the tumour is confined to the inner bowel wall (stage A) or into the superficial bowel wall without reaching the outer coat (the serosa in the case of the colon) = stage B1, or whether there is full penetration through the bowel wall with local extension through into the surrounding tissues (stage B2). If the lymph nodes in the operative specimen are involved then the staging is C and if there is evidence of spread to other organs then the patient is referred to as having metastatic colorectal cancer.


These staging categories are important as they influence the treating doctors as to which patients are at higher risk of subsequent relapse and who should receive adjunctive post-operative therapy. The staging A-C being progressively les favourable with five year survivals of 80% for stage A, 60% for stage B and 30% for stage C; less than 5% of patients presenting with overt metastatic disease will be alive at five years.

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