Staging is a way to measure the spread of a cancer. The later the stage, the greater the risk of recurrence of the cancer. This gives your doctor a way to predict your risks and to advise if further treatment is required.

Identifying the stage and extent of the cancer goes a long way in predicting outcomes and determining future treatment plans.

Most treatments are based on the TNM system. T is for tumour, and it is giving a number of 1 to 4 depending on the depth of invasion of the tumour at the wall of the colon or rectum. N is nodal status and is given based on the number of affected lymph nodes around the region. N0 is given when none of the surrounding lymph nodes are affected.

The greater the number of affected nodes, the larger the N number (0,1 or 2). M stands for metastasis. This means that the cancer has spread to distant organs. M0 means no metastasis and M1 means it has spread. M1 almost always equates to a stage 4 cancer. Various combinations of the T, N and M stage will give the actual stage of the disease.

AJCC Stage	TNM stage	TNM stage criteria for colorectal cancer
Stage I	T1 N0 M0	T1: Tumor invades submucosa
Stage I	T2 N0 M0	T2: Tumor invades muscularis propria
Stage II-A	T3 N0 M0	T3: Tumor invades subserosa or beyond (without other organs involved)
Stage II-B	T4 N0 M0	T4: Tumor invades adjacent organs or perforates the visceral peritoneum
Stage III-A	T1-2 N1 M0	N1: Metastasis to 1 to 3 regional lymph nodes. T1 or T2.
Stage III-B	T3-4 N1 M0	N1: Metastasis to 1 to 3 regional lymph nodes. T3 or T4.
Stage III-C	any T, N2 M0	N2: Metastasis to 4 or more regional lymph nodes. Any T.
Stage IV	any T, any N, M1	M1: Distant metastases present . Any T , any N.

Our clinic is dedicated to the diagnosis and treatment of colorectal cancer.

Once the stage has been determined, we will ensure the patient is well taken care of with his or her best interests in mind.

Cancer staging is accurate only after removal of the cancer. It is not possible to tell the stage of a cancer at the time of colonoscopy. This is because a colonoscopy only allows your doctor to see the inside of your colon and will not be able to see the lymph nodes nor other organs such as the liver or lung.

CT scans will be able to tell if there is or is not metastasis (the M stage). It is not sensitive enough to tell the status of the lymph nodes. Hence, if there is no spread to the liver or lung in the scan, the only conclusion that can be drawn is that it is not a stage 4 cancer.

Read on for More Information on Colorectal Cancer:

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Polyps Of The Colon And Rectum

Our Colorectal Cancer
Surgeon

Dr Ho Kok Sun

Colorectal & General Surgeon

MBBS (Singapore), M Med (Gen Surg) (Singapore), FRCSEd (Gen Surg), FAMS

Dr Ho Kok Sun has been committed to treating colorectal cancer in Singapore for over a decade. He was the past President of the ASEAN Society of Colorectal Surgeons and the Society of Colorectal Surgeons (Singapore), as well as a founding member of the Eurasian Colorectal Technologies Association. Dr Ho was actively involved in the training of medical students and residents, and has published widely in reputable journals and book chapters. He believes that treatment should always be personalised to the patient’s needs.

Determining Its Stages

Our Colorectal Cancer Surgeon

Our Colorectal Cancer
Surgeon