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TNM and Stage Groupings > Colon and Rectum
Colon and Rectum
Primary Tumor (T)
| T Category |
Stage Category Definitions |
| TX |
Primary tumor cannot be assessed |
| T0 |
No evidence of primary tumor |
| Tis |
Carcinoma in situ: intraepithelial or invasion of lamina propria* |
| T1 |
Tumor invades submucosa |
| T2 |
Tumor invades muscularis propria |
| T3 |
Tumor invades through the muscularis propria into pericolorectal tissues |
| T4a |
Tumor penetrates to the surface of the visceral peritoneum** |
| T4b |
Tumor directly invades or is adherent to other organs or structures^,** |
*Note: Tis includes cancer cells confined within the glandular basement membrane
(intraepithelial) or mucosal lamina propria (intramucosal) with no extension
through the muscularis mucosae into the submucosa.
^Note: Direct invasion in T4 includes invasion of other organs or other segments of the
colorectum as a result of direct extension through the serosa, as confirmed on
microscopic examination (for example, invasion of the sigmoid colon by a
carcinoma of the cecum) or, for cancers in a retro-peritoneal or subperitoneal
location, direct invasion of other organs or structures by virtue of extension
beyond the muscularis propria (i.e., respectively, a tumor on the posterior wall of
the descending colon invading the left kidney or lateral abdominal wall; or a mid or
distal rectal cancer with invasion of prostate, seminal vesicles, cervix or vagina).
**Tumor that is adherent to other organs or structures, grossly, is classified cT4b.
However, if no tumor is present in the adhesion, microscopically, the classification
should be pT1-4a depending on the anatomical depth of wall invasion. The V and
L classifications should be used to identify the presence or absence of vascular or
lymphatic invasion whereas the PN site-specific factor should be used for
perineural invasion.
Regional Lymph Nodes (N)
| N Category |
Stage Category Definitions |
| NX |
Regional lymph nodes cannot be assessed |
| N0 |
No regional lymph node metastasis |
| N1 |
Metastasis in 1 to 3 regional lymph nodes |
| N1a |
Metastasis in 1 regional lymph node |
| N1b |
Metastasis in 2-3 regional lymph nodes |
| N1c |
Tumor deposit(s) in the subserosa, mesentery, or non-peritonealized
pericolic or perirectal tissues without regional nodal metastasis |
| N2 |
Metastasis in 4 or more regional lymph nodes |
| N2a |
Metastasis in 4 to 6 regional lymph nodes |
| N2b |
Metastasis in 7 or more regional lymph nodes |
Note: A satellite peritumoral nodule in the pericolorectal adipose tissue of a primary
carcinoma without histologic evidence of residual lymph node in the nodule may
represent discontinuous spread, venous invasion with extravascular spread (V1/2) or a
totally replaced lymph node (N1/2). Replaced nodes should be counted separately as
positive nodes in the N category, whereas discontinuous spread or venous invasion
should be classified and counted in the Site-Specific Factor category Tumor Deposits
(TD).
Distant Metastasis (M)
| M Category |
Stage Category Definitions |
| M1 |
Distant metastasis |
| M1a |
Metastasis confined to one organ or site (e.g., liver, lung, ovary, non-regional node). |
| M1b |
Metastases in more than one organ/site or the peritoneum. |
No distant metastasis (no pathologic M0; use clinical M to complete stage group)
Anatomic Stage/Prognostic Groups
| Stage |
T |
N |
M |
| 0 |
Tis |
N0 |
M0 |
| I |
T1 |
N0 |
M0 |
| I |
T2 |
N0 |
M0 |
| IIA |
T3 |
N0 |
M0 |
| IIB |
T4a |
N0 |
M0 |
| IIC |
T4b |
N0 |
M0 |
| IIIA |
T1-T2 |
N1/N1c |
M0 |
| IIIA |
T1 |
N2a |
M0 |
| IIIB |
T3-T4a |
N1/N1c |
M0 |
| IIIB |
T2-T3 |
N2a |
M0 |
| IIIB |
T1-T2 |
N2b |
M0 |
| IIIC |
T4a |
N2a |
M0 |
| IIIC |
T3-T4a |
N2b |
M0 |
| IIIC |
T4b |
N1-N2 |
M0 |
| IVA |
Any T |
Any N |
M1a |
| IVB |
Any T |
Any N |
M1b |
*Dukes B is a composite of better (T3 N0 M0) and worse (T4 N0 M0)
prognostic groups, as is Dukes C (Any TN1 M0 and Any T N2 M0). MAC is
the modified Astler-Coller classification.
