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__NOTOC__
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{{Colon cancer}}
{{Colon cancer}}
{{CMG}}; {{AE}}
To view the staging of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis staging|'''here''']]<br>
To view the staging of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer staging|'''here''']]<br><br>
{{CMG}} {{AE}}; {{RAK}} Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.


== Overview ==
== Overview ==
 
The diagnostic study of choice for colorectal cancer is [[colonoscopy]] due to its ability to visualize the [[tumor]] in its location and take biopsies from lesions in the [[colon]].
<br />
== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
The diagnostic study of choice for colorectal cancer is [[colonoscopy]] due to its ability to visualize the [[tumor]] in its location and take biopsies from lesions in the [[colon]].


OR
A [[colonoscopy]] checks for polyps and other abnormalities in the entire colon and rectum. A [[colonoscopy]] has the advantage that if [[Polyp (medicine)|polyp]]s are found during the procedure they can be immediately removed, and the tissue can also be taken for [[biopsy]]. The [http://www.asge.org/ American Society for Gastrointestinal Endoscopy] has released quality indicators for screening colonoscopy, which include:<ref name="pmid16635231">{{cite journal| author=Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE et al.| title=Quality indicators for colonoscopy. | journal=Am J Gastroenterol | year= 2006 | volume= 101 | issue= 4 | pages= 873-85 | pmid=16635231 | doi=10.1111/j.1572-0241.2006.00673.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16635231  }}</ref>
*Documentation of prep quality
*Photo documentation of cecal [[intubation]]
*Withdrawal time of 6 minutes or more
*[[Adenoma]] detection rate of greater than 25% in males and 15% in females greater than 50 years old.


The following result of [gold standard test] is confirmatory of [disease name]:
A [[biopsy]] can be performed when a suspected lesion is found on [[colonoscopy]]. The biopsy specimen is examined for histologic changes and tissue differentiation. Well-differentiated [[lesions]] have a good prognosis compared to poorly and undifferentiated [[lesions]].<ref name="pmid16635231" />
* [Result 1]
===Colorectal Cancer Staging===
* [Result 2]
* Staging of colorectal cancer is calculated after the diagnosis has been established in order to assess treatment and prognosis.
* Definitive staging can only be achieved after [[Colectomy|surgery]] has been performed and [[pathology]] reports have been reviewed.
* The most recent revision (2017) of the tumor, node, metastasis staging system (TNM) proposed by the American Joint Committe on Cancer and the Union for International Cancer Control is widely used.
* This staging system depends on 3 main factors including the size of the tumor ('''T'''), the degree of lymph node involvement ('''N'''), and the presence or absence of distant metastasis ('''M''').<ref name=":0">{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>


OR
*


[Name of the investigation] must be performed when:
{| class="wikitable"
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Category
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Criteria
|-
| colspan="2" style="background:#A9A9A9;" align="left" + |T - Primary tumor
|-
| style="background:#DCDCDC;" align="left" + |TX
| style="background:#F5F5F5;" align="left" + |Primary tumor cannot be assessed
|-
| style="background:#DCDCDC;" align="left" + |T0
| style="background:#F5F5F5;" align="left" + |No evidence of primary tumor
|-
| style="background:#DCDCDC;" align="left" + |Tis
| style="background:#F5F5F5;" align="left" + |Carcinoma in situ (intraepithelial or invasion of lamina propria)
|-
| style="background:#DCDCDC;" align="left" + |T1
| style="background:#F5F5F5;" align="left" + |Tumor invades the submucosa
|-
| style="background:#DCDCDC;" align="left" + |T2
| style="background:#F5F5F5;" align="left" + |Tumor invades the muscularis propria
|-
| style="background:#DCDCDC;" align="left" + |T3
| style="background:#F5F5F5;" align="left" + |Tumor invades through the muscularis propria into subserosa or into pericolic/perirectal tissues
|-
| style="background:#DCDCDC;" align="left" + |T4
| style="background:#F5F5F5;" align="left" + |Tumor directly invades other organs and/or perforates visceral peritoneum
|-
| style="background:#DCDCDC;" align="center" + |T4a
| style="background:#F5F5F5;" align="left" + |Tumor perforates through the visceral peritoneum
|-
| style="background:#DCDCDC;" align="center" + |T4b
| style="background:#F5F5F5;" align="left" + |Tumor directly invades other organs
|-
| colspan="2" style="background:#A9A9A9;" align="left" + |N - Regional lymph nodes
|-
| style="background:#DCDCDC;" align="left" + |NX
| style="background:#F5F5F5;" align="left" + |Regional lymph nodes cannot be assessed
|-
| style="background:#DCDCDC;" align="left" + |N0
| style="background:#F5F5F5;" align="left" + |No regional lymph node metastasis
|-
| style="background:#DCDCDC;" align="left" + |N1
| style="background:#F5F5F5;" align="left" + |Metastasis to one to three regional lymph nodes
|-
| style="background:#DCDCDC;" align="center" + |N1a
| style="background:#F5F5F5;" align="left" + |Metastasis to one regional lymph node
|-
| style="background:#DCDCDC;" align="center" + |N1b
| style="background:#F5F5F5;" align="left" + |Metastasis to two or three regional lymph nodes
|-
| style="background:#DCDCDC;" align="center" + |N1c
| style="background:#F5F5F5;" align="left" + |Negative regional lymph nodes, but spread into areas of fat near the lymph nodes
|-
| style="background:#DCDCDC;" align="left" + |N2
| style="background:#F5F5F5;" align="left" + |Metastasis to four or more regional lymph nodes
|-
| style="background:#DCDCDC;" align="center" + |N2a
| style="background:#F5F5F5;" align="left" + |Metastasis to four to six regional lymph nodes
|-
| style="background:#DCDCDC;" align="center" + |N2b
| style="background:#F5F5F5;" align="left" + |Metastasis to seven or more regional lymph nodes
|-
| colspan="2" style="background:#A9A9A9;" align="left" + |M - Distant metastasis
|-
| style="background:#DCDCDC;" align="left" + |MX
| style="background:#F5F5F5;" align="left" + |Distant metastasis cannot be assessed
|-
| style="background:#DCDCDC;" align="left" + |M0
| style="background:#F5F5F5;" align="left" + |No distant metastasis
|-
| style="background:#DCDCDC;" align="center" + |M1
| style="background:#F5F5F5;" align="left" + |Distant metastasis
|-
| style="background:#DCDCDC;" align="center" + |M1a
| style="background:#F5F5F5;" align="left" + |Metastasis to one organ/site without peritoneal metastasis
|-
| style="background:#DCDCDC;" align="center" + |M1b
| style="background:#F5F5F5;" align="left" + |Metastasis to two or more organs/sites without peritoneal metastasis
|-
| style="background:#DCDCDC;" align="center" + |M1c
| style="background:#F5F5F5;" align="left" + |Metastasis to the peritoneal surface and/or metastasis to other organs/sites
|}


OR
==== Stage grouping<ref name=":0" /> ====
 
{| class="wikitable"
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage 0
 
| style="background:#F5F5F5;" align="center" + |Tis
OR
| style="background:#F5F5F5;" align="center" + |N0
 
| style="background:#F5F5F5;" align="center" + |M0
The diagnostic study of choice for [disease name] is [name of the investigation].
|-
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage I
OR
| style="background:#F5F5F5;" align="center" + |T1-T2
 
| style="background:#F5F5F5;" align="center" + |N0
There is no single diagnostic study of choice for the diagnosis of [disease name].
| style="background:#F5F5F5;" align="center" + |M0
 
|-
OR
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IIA
 
| style="background:#F5F5F5;" align="center" + |T3
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
| style="background:#F5F5F5;" align="center" + |N0
 
| style="background:#F5F5F5;" align="center" + |M0
OR
|-
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IIB
[Disease name] is primarily diagnosed based on the clinical presentation.
| style="background:#F5F5F5;" align="center" + |T4a
 
| style="background:#F5F5F5;" align="center" + |N0
OR
| style="background:#F5F5F5;" align="center" + |M0
 
|-
Investigations:
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IIC
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
| style="background:#F5F5F5;" align="center" + |T4b
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
| style="background:#F5F5F5;" align="center" + |N0
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
| style="background:#F5F5F5;" align="center" + |M0
 
|-
==== The comparison of various diagnostic studies for [disease name] ====
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IIIA
{|
| style="background:#F5F5F5;" align="center" + |T1-T2
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| style="background:#F5F5F5;" align="center" + |N1/N1c
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
| style="background:#F5F5F5;" align="center" + |M0
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
| style="background:#F5F5F5;" align="center" + |T1
| style="background:#F5F5F5;" align="center" + |N2a
| style="background:#F5F5F5;" align="center" + |M0
|-
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IIIB
| style="background:#F5F5F5;" align="center" + |T3-T4a
| style="background:#F5F5F5;" align="center" + |N1/N1c
| style="background:#F5F5F5;" align="center" + |M0
|-
| style="background:#F5F5F5;" align="center" + |T2-T3
| style="background:#F5F5F5;" align="center" + |N2a
| style="background:#F5F5F5;" align="center" + |M0
|-
| style="background:#F5F5F5;" align="center" + |T1-T2
| style="background:#F5F5F5;" align="center" + |N2b
| style="background:#F5F5F5;" align="center" + |M0
|-
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IIIC
| style="background:#F5F5F5;" align="center" + |T4a
| style="background:#F5F5F5;" align="center" + |N2a
| style="background:#F5F5F5;" align="center" + |M0
|-
| style="background:#F5F5F5;" align="center" + |T3-T4a
| style="background:#F5F5F5;" align="center" + |N2b
| style="background:#F5F5F5;" align="center" + |M0
|-
| style="background:#F5F5F5;" align="center" + |T4b
| style="background:#F5F5F5;" align="center" + |N1-N2
| style="background:#F5F5F5;" align="center" + |M0
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IVA
| style="background:#F5F5F5;" align="center" + |any T
| style="background:#F5F5F5;" align="center" + |any M
| style="background:#F5F5F5;" align="center" + |M1a
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IVB
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#F5F5F5;" align="center" + |any T
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#F5F5F5;" align="center" + |any M
| style="background:#F5F5F5;" align="center" + |M1b
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage IVC
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#F5F5F5;" align="center" + |any T
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#F5F5F5;" align="center" + |any M
| style="background:#F5F5F5;" align="center" + |M1c
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>


===== Diagnostic results =====
==References==
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
{{Reflist|2}}
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].


OR
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Mature chapter]]


'''IF there are no established diagnostic criteria'''
{{WikiDoc Help Menu}}
 
{{WikiDoc Sources}}
There are no established criteria for the diagnosis of [disease name].
[[Category:Up-To-Date]]
 
[[Category:Oncology]]
==References==
[[Category:Medicine]]
{{Reflist|2}}
[[Category:Gastroenterology]]
{{WH}}
[[Category:Surgery]]
{{WS}}

Latest revision as of 20:07, 10 October 2019

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To view the staging of familial adenomatous polyposis (FAP), click here
To view the staging of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Roukoz A. Karam, M.D.[2] Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.

Overview

The diagnostic study of choice for colorectal cancer is colonoscopy due to its ability to visualize the tumor in its location and take biopsies from lesions in the colon.

Diagnostic Study of Choice

Study of choice

The diagnostic study of choice for colorectal cancer is colonoscopy due to its ability to visualize the tumor in its location and take biopsies from lesions in the colon.

A colonoscopy checks for polyps and other abnormalities in the entire colon and rectum. A colonoscopy has the advantage that if polyps are found during the procedure they can be immediately removed, and the tissue can also be taken for biopsy. The American Society for Gastrointestinal Endoscopy has released quality indicators for screening colonoscopy, which include:[1]

  • Documentation of prep quality
  • Photo documentation of cecal intubation
  • Withdrawal time of 6 minutes or more
  • Adenoma detection rate of greater than 25% in males and 15% in females greater than 50 years old.

A biopsy can be performed when a suspected lesion is found on colonoscopy. The biopsy specimen is examined for histologic changes and tissue differentiation. Well-differentiated lesions have a good prognosis compared to poorly and undifferentiated lesions.[1]

Colorectal Cancer Staging

  • Staging of colorectal cancer is calculated after the diagnosis has been established in order to assess treatment and prognosis.
  • Definitive staging can only be achieved after surgery has been performed and pathology reports have been reviewed.
  • The most recent revision (2017) of the tumor, node, metastasis staging system (TNM) proposed by the American Joint Committe on Cancer and the Union for International Cancer Control is widely used.
  • This staging system depends on 3 main factors including the size of the tumor (T), the degree of lymph node involvement (N), and the presence or absence of distant metastasis (M).[2]
Category Criteria
T - Primary tumor
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 the submucosa
T2 Tumor invades the muscularis propria
T3 Tumor invades through the muscularis propria into subserosa or into pericolic/perirectal tissues
T4 Tumor directly invades other organs and/or perforates visceral peritoneum
T4a Tumor perforates through the visceral peritoneum
T4b Tumor directly invades other organs
N - Regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis to one to three regional lymph nodes
N1a Metastasis to one regional lymph node
N1b Metastasis to two or three regional lymph nodes
N1c Negative regional lymph nodes, but spread into areas of fat near the lymph nodes
N2 Metastasis to four or more regional lymph nodes
N2a Metastasis to four to six regional lymph nodes
N2b Metastasis to seven or more regional lymph nodes
M - Distant metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Metastasis to one organ/site without peritoneal metastasis
M1b Metastasis to two or more organs/sites without peritoneal metastasis
M1c Metastasis to the peritoneal surface and/or metastasis to other organs/sites

Stage grouping[2]

Stage 0 Tis N0 M0
Stage I T1-T2 N0 M0
Stage IIA T3 N0 M0
Stage IIB T4a N0 M0
Stage IIC T4b N0 M0
Stage IIIA T1-T2 N1/N1c M0
T1 N2a M0
Stage IIIB T3-T4a N1/N1c M0
T2-T3 N2a M0
T1-T2 N2b M0
Stage IIIC T4a N2a M0
T3-T4a N2b M0
T4b N1-N2 M0
Stage IVA any T any M M1a
Stage IVB any T any M M1b
Stage IVC any T any M M1c

References

  1. ↑ 1.0 1.1 Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE; et al. (2006). "Quality indicators for colonoscopy". Am J Gastroenterol. 101 (4): 873–85. doi:10.1111/j.1572-0241.2006.00673.x. PMID 16635231.
  2. ↑ 2.0 2.1 Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.


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