Dr. Edith Mitchell

Last night, Dr. Edith Mitchell of Thomas Jefferson University Kimmel Cancer Center in Philadelphia, PA, updated colorectal cancer patients on the latest research and treatment news in an online webinar.

Dr. Mitchell highlighted the most important news for colon and rectal cancer patients to come from the 2011 Gastrointestinal Cancers Symposium held in San Francisco last month. She answer such questions as…

“Can doctors determine the chances that my cancer may return?”

“Can my doctors determine if I need chemotherapy?”

“Does Avastin or Erbitux benefit my stage III cancer treatment?”

“Are there any promising new treatments on the horizon?”

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It is important to stage somebody correctly that you examine a reasonable number of lymph nodes.

Many studies now show that the ideal number is 12 or higher. We know that if you have no lymph nodes involved with cancer out of 12 lymph nodes that you really have stage II disease.  You might wonder when only two nodes are removed and none are involved in cancer if additional lymph nodes could show cancer. Therefore, even when the pathological stage is II, we would classify this tumor as not well-staged and treat it like a stage III cancer. Read the rest of this entry »

Experts in treating colorectal cancer that has spread to distant sites say that the need for a better staging system for advanced disease is urgent. More specific staging could identify patients whose cancer could be cured with surgery.  For others, modern chemotherapy might make curative surgery possible.

In addition, a more precise staging system, with more categories, would provide better survival prognosis.

Currently all patients whose cancer has spread beyond their colon or rectum to distant sites (metastatic colorectal cancer) are lumped together in one group, classified as stage IV or Dukes D.  No difference is made for those who have liver tumors that could be surgically removed or those where chemotherapy might make surgical cure possible. Read the rest of this entry »

Advance Abstracts from ASCO 2008

How far a colon or rectal cancer penetrates through the wall of the bowel may be more important in deciding survival risks than current staging that focuses on positive lymph nodes.

Five year survival statistics for a large number of rectal and cancer patients verified an earlier study that found some stage III colorectal cancers had better prognosis than stage II cancers that extended through the bowel wall but did not invade nearby lymph nodes.

The information has implications for treating colorectal cancer after surgery.

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Staging is an important part of diagnosis, treatment planning, and predictions of long term survival. Once a stage is decided at initial diagnosis it does not change, although the cancer may recur or spread later.

As colorectal cancer progresses from Stage 0 to Stage IV, the cancer cells grow outward through the layers of the colon or rectum wall and spread to nearby lymph nodes and to other organs.

Colon and rectal cancer staging depends on three factors:

1. T—for Tumor: How far the tumor extends from the inner lining of the colon through the layers of its walls. See diagram below.
2. N—for Nodes: Whether cancer cells are found in the lymph nodes draining the colon near the site of the cancer and how many nodes are affected. Lymph nodes are small, bean-shaped structures found throughout the body that filter substances in a fluid called lymph and help fight infection and disease).
3. M—for Metastasis: Whether cancer has spread beyond the colon and its adjacent tissues to distant organs like the lungs or liver.

Colon and rectal cancer have similar definitions of staging.

Stage 0 (Carcinoma in Situ)

Colorectal: (Ts,N0,M0) In stage 0, the cancer is found in the innermost lining (mucosa) of the colon or rectum only. Stage 0 cancer is also called carcinoma in situ.

Stage I

Colon (T1,N0, M0 or T2,N0, M0) In stage I, the cancer has spread beyond the innermost tissue layer of the colon wall to the middle layers.

Rectal: In stage I, cancer has spread beyond the innermost lining of the rectum to the second and third layers and involves the inside wall of the rectum, but it has not spread to the outer wall of the rectum or outside the rectum.

Stage II

Colon: Stage II colon cancer is divided into stage IIA and stage IIB.

• Stage IIA  (T3,N0,M0): Cancer has spread beyond the middle tissue layers of the colon wall or has spread to nearby tissues around the colon.
• Stage IIB: (T4,N0,M0): Cancer has spread beyond the colon wall into nearby organs and/or through the serosa (tissue lining the colon).

Rectal: In stage II, cancer has spread outside the rectum to nearby tissue, but it has not gone into the lymph nodes.

Stage III

Colon

• Stage IIIA (T1,N1,M0) or (T2,N1,M0): Cancer has spread from the innermost layer of the colon wall to the middle layers and has spread to 1 to 3 lymph nodes.
• Stage IIIB (T3,N1,MO or T4,N1,M0): Cancer has spread to as many as three nearby lymph nodes (N1) and has spread:
  • beyond the middle tissue layers of the colon wall; or
  • to nearby tissues around the colon or rectum; or
  • beyond the colon wall into nearby organs and/or through the serosa.
• Stage IIIC (Any T,N2,M0): Cancer has spread to four or more nearby lymph nodes (N2) and has spread:
  • to or beyond the middle tissue layers of the colon wall; or
  • to nearby tissues around the colon or rectum; or
  • to nearby organs and/or through the serosa.

Rectal: In stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.

Stage IV

Colorectal (Any T Any N, M1)

In stage IV, cancer has spread beyond the colon or rectal to other parts of the body, such as the liver, lungs, abdominal lining (peritoneum), or ovaries.

• Stage IVA: Cancer has spread to only one organ or site (for example, liver, lung, ovary, nonregional node).
• Stage IVB: Cancer has spread to more than one organ/site or the peritoneum.

Recurrent

Recurrent cancer is cancer that has returned after treatment.  It may be:

• Locally recurrent:  returns in the region nearby the colon or rectum
• Distantly recurrent or metastatic: Returns somewhere in the body beyond the original location in the colon or rectum

Where Can You Go for More Information?

American Cancer Society How is Colorectal Cancer Staged has detailed information about colon and rectal cancer staging.

American Joint Committee on Cancer (AJCC) has more general information about  cancer staging in What is Cancer Staging. as well as an excellent poster that can be downloaded and printed.

Cancer.Net, patient information from the American Society of Clinical Oncology, has staging information that includes good graphics and information about cancer grades.