Table 1.
Staging classification of CRCs using letters A to C or D
| All without LN metastasis | ||||
| 1st author or classification, year (ref) | Stage A | Stage B | Stage C | Stage D |
| Dukes, 1932 (1) | Without penetration through the muscularis propria; limited to the wall of the rectum | Penetrating through the bowel wall (muscularis propria) | With LN metastasis | No stage D |
| Gabriel–Dukes, 1935 (4) | Without penetration through the muscularis propria; limited to the wall of the rectum Same as Dukes1 | Penetrating through the bowel wall (muscularis propria) Same as Dukes1 | C1: regional LN involvement without apical LN involvement | No stage D |
| C2: apical LN involvement | ||||
| Kirklin, 1949 (5) “slight modification of the Dukes’s method”* | Limited to the mucosa | B1: infiltrating the submucosa or the muscularis propria, without penetrating this later | With LN metastasis Same as Dukes1 | No stage D |
| B2: penetrating through the muscularis propria | ||||
| Astler–Coller, 1954 (6) “modified Dukes’s”* | Limited to the mucosa Same as Kirklin5 | B1: infiltrating the submucosa or the muscularis propria, without penetrating this later | C1: like B1 but with LN involvement C2: like B2 but with LN involvement |
No stage D |
| B2: penetrating through the muscularis propria Same as Kirklin5 | ||||
| Turnbull, 1967 (7) | Without penetration through the muscularis propria; limited to the wall of the rectum Same as Dukes1 | Penetrating through the bowel wall (muscularis propria) Same as Dukes1 | C: tumour metastasis to regional mesenteric LNs, but no distant metastasis | D: distant metastasis, seeding of tumour, irremovable tumour because of parietal invasion, adjacent organ invasion. |
| Gunderson, 1974 (8) “modified Astler–Coller”* | Limited to the mucosa Same as Kirklin5 |
B1: infiltrating the submucosa or the muscularis propria, without penetrating this later | C1: like B1 but with LN involvement C2: like B2 but with LN involvement |
No stage D |
| B2: penetrating through the muscularis propria | C3: like B3 but with LN involvement | |||
| B3: lesions adherent to or invading adjacent organs or structures | ||||
| Pihl, 1980 (9) | A1: intramucosal or invading into submucosa but not beyond | Penetrating through the bowel wall (muscularis propria) Same as Dukes1 |
C1: regional LN involvement without apical LN involvement | D1: Tumour invading adjacent organs (such as prostate, bladder, uterus, small bowel) D2: Tumour with distant metastases |
| A2: infiltrating the muscularis propria but not penetrating through this layer | C2: apical LN involvement Same as Gabriel-Dukes4 |
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| Australian clinico-pathological staging system, 1983 (10)† | A: invading into bowel wall, but not beyond the muscularis propria; without LN or distant metastasis | B: spread beyond the muscularis propria into adjacent tissue in continuity or into adjacent organs; without LN or distant metastasis | C: spread into or through muscularis propria with LN metastases and without distant metastases | D: Evidence of cancer remaining locally or at distant site |
| Gastrointestinal tumor study group, 1985 (11) “modified Dukes’s”* | A: not defined, probably same as Dukes1 | B1: not defined | C1: metastasis in 1 to 4 LNs | No stage D |
| B2: extension through the rectal wall | C2: metastasis to more than 4 LNs | |||
| Australian clinico-pathological staging system, 1987 (12) modified | A1: intramucosal | B1: beyond muscularis propria, free mesothelial surface not invaded, no tumour in lines of resection, no distant metastasis | C1: metastasis to local LNs, no tumour in lines of resection, no distant metastasis | D1: Tumour involving line of resection |
| A2: invading into submucosa but not beyond | B2: as for B1, but free mesothelial surface invaded (not applicable to distal rectum) | C2: metastasis to an apical LN, no tumour in lines of resection, no distant metastasis. | D2: Distant metastasis present | |
| A3: infiltrating the muscularis propria but not penetrating through this layer | ||||
| Cohen, 1989 (13) “modified Astler–Coller”* | With invasion into submucosa | B1: with invasion into muscularis propria | C1: like B1 but with LN involvement | No stage D |
| B2: not well defined enough, corresponding to T3 or T4N0M0 of the TNM14 | C2: like B2 but with LN involvement | |||
| B3: corresponding to T4N0M0 of the TNM14 | C3: like B3 but with LN involvement | |||
| Hyder, 1990 (15) | Without penetration through the muscularis propria; limited to the wall of the rectum Same as Dukes1 | Penetrating through the bowel wall (muscularis propria) Same as Dukes1 |
C1: infiltration not beyond the muscularis propria and 1 to 4 positive LNs | D: widespread or contiguous organ spread, or distant metastasis present |
| C2: >4 LNs positive, or any LN metastasis and penetration beyond muscularis propria | ||||
| AJCC, 2002 (16) “modified Astler–Coller”* | With invasion to submucosa | B1: with invasion into but not through muscularis propria | C1: like B1 but with LN involvement | D: with distant metastasis |
| B2: with invasion through muscularis propria | C2: like B2 but with LN involvement | |||
| B3: corresponding to T4N0M0 of the TNM 6th edition17 | C3: like B3 but with LN involvement | |||
*Eponymous forms taken from the references; †stage O for tumours confined to the mucosa; category X for cases where no lymphadenectomy has been performed; category Y for unknown pathology details.
CRC, colorectal carcinoma; LN, lymph node.