Colon Cancer Grading and Staging | oncotest
Colon Cancer
Colon Cancer
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Colon Cancer Grading and Staging

Characterization of the unique biological properties of your tumor for developing your treatment plan.

 The pathology report

The pathology report provides detailed information on your colon cancer. This information is received from the tests that are performed in the biopsy sample or surgical sample taken from your tumor. It is important to discuss the pathology report with your physician as soon as you get the results.

Your pathology report may contain the following information:
The type of tumor cells – the type of cells that form your tumor
The grade of the tumor – describes how much the tumor cells look different to the normal cells of the colon
The depth of the tumor – the degree of invasion or spread of the tumor into nearby tissues
The size of the tumor – usually reported in millimeters or centimeters (1 cm = 10 mm)
Surgical margins – the quantity of healthy tissue that is to be found around the edge of tumor tissue that has been removed during the operation.

  • Negative margins – the malignant tumor has been completely removed during the operation
  • Positive margins – traces of malignant cells may be left after the operation


Involvement of the lymphatic and vascular system – whether the cancer cells have invaded the blood vessels and lymphatic drainage system

State of the lymph nodes – whether malignant cells have been discovered in the lymph nodes that were removed during the operation
Mismatch repair status (MMR) – tests for damage in the mismatch repair system (MMR-D) – an acquired or hereditary biological characteristic that is related to certain types of colon cancer.

 MMR recurrence and status
The information on the status of your MMR may assist you and your physician in making therapeutic decisions Studies have shown that patients who have stage II colon cancer whose tumor has a defect in the mismatch repair system (MMR-deficient – MMR-D) are at lower risk for recurrence of the disease compared to those who have tumors without a mismatch repair system defect (MMR-proficient – MMR-P).*

Grading and staging of colon cancer
The information that is included in your pathological report, in addition to other factors, such as age, general health condition, your medical and family history – helps you and your physician in making therapeutic decisions.

 Grading of colon cancer
“Grading” is a term that is used for describing the degree of resemblance of cells in a tumor and normal tissue cells, as observed under the microscope. The higher the grade, the more significant the difference between the tumor cells and the normal cells is. For example, low grade tumor cells look like normal cells, whereas high grade tumor cells look different to normal cells. The tumor grade is more important for some types of malignant tumors than other tumors.

 Staging of colon cancer
Staging is a method for organizing information on the colon cancer that you have that helps the physician describe your tumor and its degree of spread. This method gives doctors a common language and is useful in making decisions about postoperative treatment options. Staging is usually done after removing the tumor and examining the lymph nodes.

 The TMN system

Staging is base don three criteria:
T (tumor) – the size and location of the tumor
N (nodes) – whether there is lymph node of the tumor
M (metastasis) – whether the cancer has spread beyond the lymph nodes.

Letters or numbers that are added after T, N and M provide further information. For example: TX means: the primary tumor cannot be evaluated; N1 means: metastases in 1 to 3 lymph nodes; M0 means: no distant metastases.


Colon cancer stages
Stage 0: (in situ) the tumor is small and limited to the inner wall of the colon
Stage I: the tumor has spread to the second and third layer of the intestinal wall but not to the outer wall
Stage II: the tumor has spread to the outer wall of the colon but not to the lymph nodes or other tissues.
Stage III: the tumor has spread to nearby lymph nodes but not to other body areas.
Stage IV: the tumor has spread to other areas, such as the liver, lungs and brain.

 *Kerr D, Gray R, Quirke P, et al. A quantitative multi-gene RT-PCR assay for prediction of recurrence in stage II colon cancer: selection of the genes in 4 large studies and results of the independent, prospectively-designed QUASAR validation study. American Society of Clinical Oncology (ASCO) Annual Meeting, 2009.
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